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Carotid Artery Disorders

Patients who have had a stroke or are at high risk of stroke are primarily evaluated and followed up by neurologists. Your neurologist will have you do some tests (Doppler USG, Brain-Neck CT-Angio or MR-Angio). One of the most common causes of stroke is plaques in the carotid arteries (carotid artery). If the stenosis formed by these plaques is serious, it may cause some complaints in the patient by disrupting the nutrition of the brain tissue on the same side. Patients who are found to have severe stenosis in the carotid arteries during the examinations are referred to a cardiovascular surgeon for further examination and treatment.

Carotid Artery Strictures: What Are The Carotid Arteries, Where Are They Located, And Why Are They Important?

Brain tissue receives the clean blood it needs to perform its normal functions through four arteries. Two of these arteries, which are fed from the aortic arch, travel to the right of our neck and the other two to the left, and travel towards the brain (see figure). Figure 1: Arteries responsible for feeding the brain SCA: subclavian arteries, VA: vertebral arteries, CCA: common carotid arteries ICA: internal carotid arteries, ECA: external carotid arteries i. Internal (internal) carotid arteries (ICA): - Internal (internal) carotid arteries are the main branches of the common carotid arteries (carotid arteries) (CCA) that feed the brain. It enters the skull by watching upwards on both front/sides of the neck. -Internal (internal) carotid arteries supply the anterior and middle parts of the cerebral hemisphere on the same side and the retina layer of the eye through the branches they give in the skull. -Internal carotid arteries carry fresh blood to 70% of the brain tissue. -External (external) carotid arteries (ECA) are the other main branches of the common carotid arteries and they give branches that feed the face, neck and scalp on the same side, they are not related to the nutrition of the brain tissue. ii. Vertebral arteries (VA): -Vertebral arteries are branches that come out of the arm arteries (subclavian arteries, SCA) going to both arms, and enter the skull by running upwards from both back/lateral sides of the neck. Vertebral arteries supply the posterior parts of the brain, the cerebellum, and the brain stem. Vertebral arteries supply 30% of the brain tissue. * Internal (internal) carotid arteries and branches of vertebral arteries form connections with each other at the base of the brain (Willis polygon). Thanks to these connections, it is tried to ensure the continuity of the cerebral circulation in case of occlusion in any vessel.

Why Is It Important To Have Plaque Causing Stenosis In The Carotid Arteries?

The tolerance of the brain tissue to lack of oxygen is so weak that brain cells that are deprived of oxygen for more than four minutes begin to die irreversibly. For this reason, stenosis or obstruction in the carotid arteries, which carry clean blood to our brain, can lead to temporary or permanent neurological disorders in the relevant parts of the brain. * The presence of plaques in the carotid arteries exposes the patient to the risk of stroke. Because a clot that will sit on a crack or tear area that will form in this cholesterol plaque can suddenly cut off the blood flow in the already narrowed vessel, causing the patient to have a stroke. (See the figure below).

How is the Decision of Intervention Made for Stenosis in the Carotid Arteries?

There are three treatment modalities in the treatment of patients with carotid stenosis: drug therapy, non-surgical (endovascular) intervention, and surgery (carotid endarterectomy). Non-surgical and operative treatment methods are complementary rather than alternatives to each other. A committee has been established in our hospital to assist patients with carotid artery stenosis in making decisions during advanced diagnosis and treatment. In this committee, called “Yücelen Hospitals Heart Team”, doctors from neurology, cardiovascular surgery, cardiology, anesthesia, internal medicine, chest diseases and occasionally radiology take place. Evaluating all aspects of the patients brought to the committee with an approach focused on the patient, not the disease, the Heart Team offers the patient the most appropriate and most beneficial treatment method in the light of national and international guidelines. In this way, it aims to help the patient make a decision about his own treatment.

What is considered when deciding on the treatment method to be recommended for a patient with carotid artery stenosis?

The parameters that are taken into consideration when deciding on the type of treatment to be recommended in a patient with carotid artery stenosis are as follows: Patient's complaints Degree of stenosis caused by the plaque in the patient's carotid artery Additional medical problems of the patient (does the patient have problems that increase the risk of the intervention to be planned?) The course and structure of the patient's carotid artery, the part after the stenosis width etc. The location and structure of the plaque causing the stenosis in the patient (being accessible by surgery, whether it is ulcerated, degree of calcification, etc.) Whether the patient has concomitant coronary artery disease.

How is Carotid Stenosis Surgery (Carotid Endarterectomy) Performed?

Since atherosclerosis is a systemic disease, patients with stenosis in their carotid arteries are more likely to have stenosis in their coronary arteries. For this reason, all our patients who are scheduled for carotid endarterectomy undergo a detailed preoperative cardiological examination and coronary imaging when necessary. In our hospital, surgeries for carotid stenosis are preferably performed under general anesthesia. During the carotid endarterectomy surgery, the brain oxygenation levels of the patients are monitored instantly with the NIRS (Near Infrared Spectroscopy) monitor. The jugular vein is found through a small incision made in the neck area where the stenosis is located, the carotid artery and its branches are clamped following the administration of blood thinners (heparin). Then, after the incision in the carotid artery where the stenosis is present, the plaque that narrows the vessel is cleaned and blood flow is restored. The surgery takes about 1-2 hours on average. Patients are usually awakened in the operating room and disconnected from the ventilator. If the patient does not need intensive care due to additional medical problems, he is taken to the service after the operation and discharged 2-3 days later. Points to be Considered by Patients with Carotid Artery Stenosis: Strictly stop smoking and tobacco use (regardless of the degree of stenosis) Regular exercise Healthy diet Weight control (patients are recommended to decrease to normal body mass index) Strict blood pressure monitoring (salt restriction and use of blood pressure medication if necessary) ) Strict sugar control (diet and, if necessary, use of sugar-lowering drugs) Using diet/cholesterol medication to keep the LDL cholesterol (bad cholesterol) level below 100 mg/dl Regular use of blood thinners recommended to the patient for a long time Regularly coming to the outpatient clinic controls Intention of Regular Exercise Why? * According to the recommendations of the AHA (American Heart Association), it is meant to prevent cardiovascular diseases: a. 30 minutes of moderate-intensity exercise 5 days a week (150 min/week) * Examples of moderate-intensity exercise: - brisk walking - cycling (less than 16 km per hour) - doing gardening - playing tennis (as a paired team) - ballroom dance b. 25 minutes of vigorous exercise 3 days a week (75min/week) * Examples of vigorous exercise: - climbing uphill or walking at a brisk pace - cycling (faster than 16 km per hour) - jogging - doing heavy gardening (hoeing, digging etc) -playing tennis (single) - aerobic dance What is a Healthy Eating? * Consumed foods; It is meant to be rich in fruits, vegetables, whole grains, legumes and nuts, moderate in low-fat dairy and seafood, and poor in processed meat products, sweetened beverages, salt, and processed grains.


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