CAROTID ARTERY DISEASE

Dr Sandra Radak, Cardiovscular Institute “DEDINJE”, Belgrade, Serbia

Carotid artery disease is responsible for the stroke in 40 % of cases. Regular carotid artery ultrasound exams and risk factors control are essential steps in stroke and vascular dementia prevention.

Cerebrovascular insult or stroke is one of the most common causes of death, and more than 25 000 people in Serbia suffer from the stroke each year. Worldwide data from developed countries demonstrate a high stroke rate, with one fatal outcome from stroke every 3 minutes. Ischemic stroke is a result of cerebral artery obstruction caused by heart conditions (fibrillation), small cerebral vessel disease, and 20 – 40% due to carotid artery disease.

Carotid arteries are the main arterial blood vessels in the neck that supplies the brain with blood, motoric, sensory, or thinking brain zones in general. Atherosclerosis is the leading cause of carotid artery stenosis. Over the years, carotid blood flow is getting reduced what results in stroke eventually. Dizziness or vertigo, temporary unilateral vision loss, impaired speech, limb weakness, headaches, or memory troubles could be warning pre-stroke symptoms.

Diagnosis Ultrasonography, along with the carotid artery color Doppler exam, is a golden diagnostic tool for carotid artery disease. An ultrasound exam is a painless and comfortable diagnostic tool for fast and precise carotid artery evaluation. It usually takes  20 to 30 minutes doctor to complete the exam. Carotid arteries are affected by atherosclerosis in more than 20% of patients undergoing coronary artery bypass surgery. Therefore ultrasonography and color Doppler carotid artery exam are always performed before bypass or open-heart surgery as well. If present, carotid artery disease will be further evaluated by an MSCT scan to obtain its 3D reconstruction necessary for further treatment.

Treatment: Carotid artery stenosis inferior to 50 %, needs no further treatment apart of regular 6 months follow exam. Stenosis above 70% has to be seen and discussed with your vascular surgeon because surgery or invasive therapy could be necessary. Generally, severe carotid artery stenosis (above 70%)  are treated by:

1. Carotid endarterectomy
2. Carotid artery balloon dilatation with stent implantation
3. Medical treatment
4. Lifestyle changes

Early diagnosis and treatment, along with risk factor control, will slow down the disease and prevent stroke and vascular dementia. Patients have to keep in mind, that severe carotid stenosis could be entirely asymptomatic, and that preventive ultrasound exams are necessary particularly in the following situations.

1. After 50 years
2. Stroke
3. Transitory stroke (TIA)
4. Temporary vision lost
5. Vertigo or dizziness
6. In the presence of hypertension, diabetes, hypercholesterolemia,
7. Smoking and family history.
8. Coronary artery disease
9. Before big surgical procedures
10. Family history of carotid disease
11. Postoperative follow-up

Following steps and lifestyle changes are an essential step to slow down the carotid disease.

1. Hypertension control
2. Diabetes control
3. Hyperlipidemia control
4. Abandon smoking
5. Balanced diet
6. Weight control
7. Physical activity of 30 min a day
8. Hydration (1,5 l of water per day )
9. Alcohol intake reduction
10. Fast food and soda drinks reduction
11. Regular ultrasound controls