Narrowing or blockage of the artery causes symptoms such as ischemia, recurrent stroke or severe stroke that threatens the life of the patient.
Causes of narrowing, carotid artery occlusion is mainly due to atherosclerosis, atherosclerotic site most of the internal carotid artery (accounting for 80% of cases).
* Risk factors for narrowing of the carotid artery include:
Age: The higher the age, the greater the risk of vascular disease in general, including atherosclerosis, according to a statistic of people age 60 and older who are at risk of narrowing - in persons under 60 years of age.
Hypertension: People with high blood pressure have a higher risk of occlusion of carotid artery than those without hypertension.
Cigarette smoking: smokers are at higher risk for cardiovascular disease than nonsmokers, including atherosclerosis and carotid artery stenosis.
Obesity, motor lazy: also risk factors of cardiovascular disease in general and atherosclerosis, carotid artery narrowing in particular.
Type 2 diabetes
* What are the symptoms of narrow, carotid arteries?
Carotid artery stenosis is common in early internal carotid arteries, with mild to severe cases that are usually asymptomatic and difficult to detect without screening for more severe prophylaxis.
In severe severe cases (≥ 70% of the vascular wall), transient ischemic attacks or transient ischemic attacks (TIA) may be indicated as localized neuromuscular signs on one leg, speaking hard, distorted, and then self-healing within 24 hours, transient ischemic attack may recur many times and is considered a very high risk factor. of stroke really if not treated; Patients may also have a stroke due to occlusion of the carotid artery; Some symptoms may be due to decreased blood flow to the brain such as drowsiness, headache, or forgetfulness, but not specific. However, there are some cases of severe narrow but no symptoms.
What to do if there are symptoms of carotid endarterectomy or in people with high risk factors?
Patients with symptoms of carotid endarterectasia or high risk factors should go to hospitals with specialized vascular disease clinics for screening.
Doctors will prescribe intravascular ultrasound and MRI (MRC) or magnetic resonance imaging (MR angiography). Finally, if narrowed, depending on the degree of narrowness, the patient will be given either prophylactic or digital extraction (DSA), digital clearing circuit is the method of accurate diagnosis. The gold standard, which offers the best treatment for patients.
When to seek treatment?
The following cases need to be treated:
- Squeezing ≥ 70% of vein
- Symptomatic strokes (transient transient strokes, recurrent stroke, ischemic symptoms), although narrowness may be less than 70%.
- Acute carotid artery occlusion
* Treatment of carotid stenosis
There are currently two main methods for treating carotid stenosis: surgical removal of plaque and narrowing of the intravascular endotracheal artery and stenting of the vein.
With Endarterectomy, the doctor opens a neck line to enter the bloodstream, then drains the vascular wall in a narrow position and removes plaque and restores blood flow. in the vein (Figure 1.2)
Figure 1. Atherosclerotic plaque extrusion model for internal carotid artery stenosis
Figure 2. Surgery of atherosclerosis
* How to warm and place carotid stent
The minimally invasive intervention involves the use of catheters and hot stents, a metal stent that leads to a narrow position that widens the vascular wall, restores normal blood flow through a narrow position. .
Treatment is indicated for patients with narrowing of ≥ 70% of veins, with clinical signs. Some patients with narrow but no clinical symptoms should also be treated for stent placement to avoid possible future events of stroke, especially in narrower cases of ≥90% .
Benefits of Intravascular Intravascular Therapy:
- Patients treated with this method are not anesthetized (mild sedation may be used during the procedure), only local anesthesia is applied to the groin.
- High success rate (> 90%)
- Time to do quick procedure
- Less complications and complications
- Quick recovery after the procedure
- Follow-up care is not complicated
Nong and carotid stent placement is done like?
- The procedure is performed at the ICU under the guidance of Digital Subtraction Angiography (DSA)
- First, doctors will perform anesthesia on the patient's inguinal area, then insert the needle into the arterial lumen of the inguinal region, and insert the catheters from the thoracic site to the approach to the carotid endocardium.
- Then the doctor will use the balloon and put the stent in a narrow position to expand the vein
- End of the procedure, the patient is taped to the position of inguinal inactivation and lying about 8 hours.
Figure 3. Stent model and stent carotid artery
Some images of patients who were given a stent carotid stent at Phu Tho General Hospital:
Figure 4. 81-year-old male patient with cerebral stroke with internal carotid artery stenosis. A, thrombocytopenia is caused by a thrombosis that moves from the narrowed artery (arrow). B, carotid stenosis in the basal segment. C, followed by stent (arrow).
Figure 5. A 39-year-old woman with cerebral infarction with left ventricular stroma. A. CT scan revealed artery occlusion at the root of the internal carotid artery (arrow); B. digital image erase background; C. The posterior stenting carotid artery repopulates the flow of blood to the brain.
BS Quang Lục