The carotid (neck jugular vein) is the main vein that carries blood to the brain. Ischemic stroke, caused by stenosis caused by fat accumulation or clot formation in the vessel wall, is an important public health problem as it is the third leading cause of long-term disability and death. The risk of stroke or transient ischemic attacks increases with age. Major risk factors for stroke:
2- high cholesterol
5- family history
6- high age
8- sleep apnea
9- sedentary-sportless life
Carotid (neck jugular vein) artery stenosis often progresses insidiously without any symptoms and only manifests itself with stroke-transient ischemic attack in advanced stenosis. Conditions such as sudden loss of strength in the arms and legs, difficulty in speaking and understanding, blurred vision, nausea and loss of balance can be seen in stroke-transient ischemic attack caused by carotid artery stenosis. Patients usually consult a doctor in case of stroke, but because transient ischemic attacks regress spontaneously within a maximum of 24 hours, they are mostly neglected by patients. When the neurological abnormality we mentioned above is experienced, a doctor should be consulted even if this situation is temporary.
It is also possible to diagnose carotid stenosis without having a stroke-temporary attack. Especially with the known heart disease and the risk factors mentioned above, a large amount of information about carotid stenosis can be obtained by Doppler examination. Angio images obtained by tomography or MRI also provide us with serious information in diagnosis. After the diagnosis of the disease, the treatment processes should be evaluated. The main purpose in the treatment of carotid artery stenosis is to protect the person from stroke. What to do if vascular stenosis is detected as mild-moderate:
1- Changing the lifestyle: quitting smoking, losing weight, changing eating habits, reducing the amount of salt intake and exercising regularly. Controlling these factors, which are also effective in the formation of the disease, is one of the most important elements of treatment.
2- In drug treatment, blood pressure medications, cholesterol lowerers, aspirin or other blood thinners are used.
If carotid stenosis is severe, it is necessary to use other methods to remove the obstruction to blood flow;
1- Carotid endarterectomy, that is, the method of cleaning the calcifications-plaques that cause the obstruction in the vessel by reaching the vessel through a surgical incision in the neck. It is a method that has been used for a long time and its effectiveness has been proven.
2- Carotid stenting is an alternative method to surgical treatment. The procedure is performed with local anesthesia and it is a proven method with studies. Mostly, carotid vessels are accessed through the groin, and a stent (metal cage) is placed in the stenosis area after a protective umbrella (filter) is placed after the stenosis. This metal mesh placed ensures the openness of the vessel. After treatment with this method, patients are recommended to use blood thinners.
The success and risk of the 2 treatment methods, namely surgery or angio treatment in severe carotid stenosis, are similar in experienced hands, so one is not superior to the other. In patient-specific cases, treatment preference may vary. The aim of both treatments is not to cure a previous stroke, the aim is to prevent stroke again. In patients who have not had a stroke, treatment can be performed according to the degree of stenosis.
In conclusion, carotid stenosis is an important disease that can be seen together with diseases such as heart disease, blood pressure and diabetes, and can cause stroke. Different treatment methods can be used according to the degree of stenosis. In severe carotid stenosis, surgical and angio treatment are effective methods, with similar success and risks.
exp. Dr. Bilal KAYA