Carotid stenosis / stenosis throat vessels
A narrowing of vessels (= stenosis) of the throat area is called carotid stenosis in case of a stenosis of the arteria carotis interna, or stenosis of arteria vertebralis if the spinal artery is affected. Arteria carotis interna is the artery that supplies the brain with blood. Often two characteristic points of the carotid artery are affected, namely the carotid bifurcation (at height of the 1./2. cervical vertebral body) and/or carotid siphon. Not treated, the carotid stenosis can cause apoplectic stroke at worst that often leads to paralyzations or death.
Symptoms carotid stenosis / stenosis of throat vessels
Carotid stenosis can cause the following symptoms:
- visual disturbances of one eye of the afflicted side with sudden, temporary blindness (so-called amaurosis fugax = temporary blindness)
- paralyzation of one side of face and/or arm, clumsiness of one hand (the symptoms are contralateral, i.e. that the opposite side of the vessel is paralyzed, e.g., in case of right carotid the left part of the face or body)
- in face or arm or the half side of the body: sensory disturbances, feeling of numbness
- language disorder
Dizziness or vertigo is no symptom of carotid stenosis since the vestibular organ is supplied by another vessel (the so-called vertebral arteries).
Diagnostics carotid stenosis / stenosis of throat vessels
Because this illness develops very slowly without being detected and has grave or life-threatening consequences, an early examination is important. The risk of an apoplectic stroke increases the longer this illness is not detected and treated. It depends on the individual carotid stenosis by which means it is diagnosed, e.g., by doppler or duplex ultrasonography, MRI angiography or angiography (depiction of vessels by a catheter).
Causes carotid stenosis / stenosis of throat vessels
The main cause of carotid stenosis is arteriosclerosis, often called artery calcification. In case of arteriosclerosis, you find deposits of blood lipids, thrombi (blood clots), connective tissue and chalk on vessel walls, leading to a stenosis of the corresponding vessel. This results in a restricted blood flow in the area which the vessel supplies with blood or to a removal of blood clots being pumped into cerebral vessels ensued by an apoplectic stroke. There are several causes of carotid stenosis:
- genetic disposition
- increased blood pressure (hypertension)
- elevated blood lipids (hyperlipidemia)
- hyperfibrinogemia (elevated concentration of fibrinogen in the blood and due to it elevated erythrocyte sedimentation rate but normal clotting of blood)
- diabetes mellitus
- inflammations (caused by bacteria or rheumatism)
Treatment carotid stenosis / stenosis of throat vessels
As resulting from abovementioned causes, diet, stress and psychological factors, genetic disposition and age play a crucial role for the emergence of carotid stenosis. Preventive measures are healthy diet, regular exercises, and stress reduction. Carotid stenosis is conservatively treated by drugs, so-called platelet aggregation inhibition drugs, e.g., acetylsalicyl acid (ASA) or clopidogrel. These drugs rule out the emergence of thromboses. Sometimes it can also be necessary to prescribe drugs for the treatment of high blood fat values. If a thrombosis occurs in throat vessels, apoplectic stroke may be the result. Generally, symptomatic and asymptomatic carotid stenoses are differentiated. Asymptomatic stenosis is accidentally detected, for example, during a cardiologic examination. Symptomatic stenosis has already caused an apoplectic stroke or, at a better case, TIA (transient ischemic attack), a neurological symptomatic only persisting for 24 hours (a so-called mini stroke, which is almost a stroke). The risk of apoplectic stroke in case of a symptomatic carotid stenosis amounts 26% after conservative treatment in opposite to 9% after surgery. As a consequence, surgery is the method of choice in terms of extreme and symptomatic stenoses. The following surgical procedures are differentiated:
- Vascular Surgery (TEA = thrombo-endarterectomy)
- neurointerventional surgery (Stent placement. The stent placement in case of carotid stenosis comes along with local anesthesia. More information on stent placement or stent implantation can be found here)
Both procedures are safe and successful given that they are carried out by an experienced surgeon. Contemporary, several scientific studies which are being evaluated and discussed are in progress. They proof the equality of both procedures if aforementioned preconditions hold. With regard to the current guidelines, the following procedere is state of the art:
- Less that 70% stenosis of the vessel – conservative drug therapyBehandlung (Stent oder CEA), wenn die
- More than 70% stenosis of the vessel – surgical treatment (stent or TEA) if the surgeon has a complication statistics of less than 1-3%
- Symptomatic stenosis describes the emergence of neurological symptoms caused by carotid stenosis within the last 6 months.
- Independent of the degree of stenosis – surgery (stent oder TEA) if the surgeon has a complication statistics of less than 3-5%