A blockage in the neck artery is called carotid artery occlusive disease. Most often, this disease is caused by the accumulation of fatty substances and cholesterol deposits that impede blood supply to the brain and increase the risk of stroke.
The function of the carotid arteries:
The carotid arteries are the two large blood vessels that supply blood to the forebrain, where the arterioles carry oxygen-rich blood. This part is responsible for thinking, speech, personality, and sensory and motor functions. You can feel the pulsation of the carotid arteries on each side of the lower neck, just below the angle of the jaw.
Atherosclerosis, a buildup of cholesterol, fats, and other substances that travel through the bloodstream, leads to a buildup of plaques and a narrowing or blockage of the carotid artery; Which may put the individual at risk of stroke.
Symptoms of a blockage in the arteries of the neck:
Carotid artery disease often has no signs or symptoms in its early stages, and the condition may go unnoticed until it becomes severe enough to deprive the brain from blood which leads to a stroke.
There are warning signs of a stroke. These signs occur when a blood clot briefly blocks an artery that supplies blood to the brain. The following symptoms can occur temporarily and may last for a few minutes or a few hours, alone or in combination:
• Sudden loss of vision or blurred vision in one or both eyes.
• Weakness and/or numbness on one side of the face, an arm or a leg, or one side of the body.
• Slurred speech, difficulty speaking or understanding what others are saying.
• Loss of coordination.
• Dizziness or confusion.
• Difficulty in swallowing.
These are strong predictors of future strokes. A person who has experienced these symptoms is 10 times more likely to have a major stroke than someone who has not experienced them.
How carotid artery disease occurs:
The carotid arteries are similar to the coronary arteries that supply blood to the heart, as both are susceptible to arteriosclerosis. Over time, the buildup of fatty substances and cholesterol narrows the carotid arteries. This reduces blood flow to the brain and increases the risk of stroke, as mentioned earlier.
A stroke is also similar to a heart attack, and it occurs when blood flow is cut off to a part of the brain where the brain cannot store oxygen, so it relies on a network of blood vessels to supply it with oxygen-rich blood. So a stroke leads to a lack of blood supply and therefore a lack of nutrients and oxygen.
A stroke can occur if:
• The artery has become very narrow due to fatty deposits.
• Refraction of part of the plaque and its transfer to the smaller arteries in the brain.
• The formation of a blood clot and blockage of the narrowed artery.
Diagnosis of carotid artery disease:
There may be no symptom of carotid artery occlusive disease. If you are at risk, it is important to have regular physical examinations.
Prof. Dr. Hossam El-Mahdy, Professor of Vascular Surgery at Cairo University, listens to the neck arteries with a stethoscope. An abnormal bursting sound may indicate carotid artery disease.
Diagnostic tests include:
Carotid duplex ultrasound: An imaging procedure using high-frequency sound waves to view the carotid arteries and determine if there is narrowing. This is the most common test to evaluate for the presence of carotid occlusive disease.
Carotid angiography (Carotid angiogram): During the imaging procedure, a catheter is inserted into a blood vessel in the arm or leg and guided into the carotid arteries with the help of X-rays with a contrast dye injected through the catheter. This test may be done to evaluate or confirm the presence of narrowing or blockages in the carotid arteries, determine future stroke risk and assess the need for treatment, such as a carotid stent.
Magnetic resonance angiography (MRA): A type of magnetic resonance imaging (MRI) that uses a magnetic field and radio waves to provide images of the carotid arteries. In many cases, MRA can provide information that cannot be obtained from an X-ray or ultrasound.
Computerized tomography angiography (CTA): A test that uses advanced computerized tomography technology, along with a dye, to obtain high-resolution 3D images of the carotid arteries, which allows the identification of narrowing in the carotid arteries and can also assess the arteries leading to them as well as blood vessels in the brain.
How is carotid artery disease treated?
Carotid artery disease is treated by:
• Lifestyle changes.
• Taking prescribed medications.
• Undergoing remedial procedures.
Lifestyle changes:
To prevent the progression of carotid artery disease, he recommends making lifestyle changes:
• Quit Smoking .
• Controlling of hypertension, hypercholesterolemia, diabetes and heart disease.
• Regular check-ups.
• Obtaining the appropriate treatment to bring the harmful fats to less than 100 and the beneficial fats to more than 45.
• Eating foods low in fat, cholesterol and sodium.
• Getting rid of excess weight.
• Regular exercise for at least 30 minutes most days of the week.
Medicines used to treat carotid artery occlusion in the neck:
All patients with carotid artery disease should take anti-platelet medication to reduce the risk of stroke and other complications of cardiovascular disease. Aspirin is one of the most widely used anti-platelet drugs.
Carotid artery occlusion procedures in the neck:
If you have symptoms related to carotid stenosis, you'll likely need a carotid endarterectomy or a carotid stent to correct the narrowing in the artery and reduce your risk of stroke. Prof. Dr. Hossam El-Mahdy will evaluate you to recommend the best treatment for your case.
If you have asymptomatic carotid artery stenosis, Prof. Dr. Hossam El-Mahdy will evaluate your test results and risk status to make a recommendation as to whether drug therapy, placing a stent in the carotid artery or carotid endarterectomy is the best option for you.
Carotid endarterectomy:
Carotid endarterectomy is the traditional surgical treatment for carotid occlusive disease. It has been shown to be beneficial for patients with symptomatic carotid artery stenosis of 50% or more, and for patients without symptoms of 60% or more.
Carotid endarterectomy is performed under general anaesthesia. During the procedure, an incision is made in the neck at the site of the carotid artery blockage. The surgeon removes the plaque from the artery and when finished, the surgeon sews the vessel closed. Blood flow to the brain is restored through its normal path.
Carotid artery stent:
The procedure is done while the patient is awake but under local anesthesia. During the procedure, with X-ray guidance, the catheter is placed through the blood vessel and guided into the carotid artery at the site of the blockage or narrowing, with the help of specially designed guide wires to reach beyond the area of the blockage.
The balloon attached to the tip of the catheter is then inflated for a few seconds to open and widen the artery. A stent is placed in the artery and opened to fit the size of the artery. The stent is permanently in place to support the artery walls and keep them open.
Research has shown that the placement of a stent in the carotid artery is as safe and effective as carotid endarterectomy, but is less risky. Therefore, you should go to Dr. Hossam El-Mahdy, Professor of vascular surgery at Cairo University, for an accurate evaluation and selection of the best treatment for you, so that you do not suffer a stroke.
