The causes and methods of treatment of plaques in the carotid artery

Atherosclerosis of the carotid arteries develops due to many reasons. We list them in order of importance:

    Dyslip >aterosklerpz sonnoi arterii - The causes and methods of treatment of plaques in the carotid artery

The mechanism of formation of atherosclerotic plaque itself is quite complex and is not fully understood.

At this point in time, scientists distinguish three main stages of atherosclerosis:

  1. The formation of lipid spots and stripes. The first link is damage to the endothelium (inner shell) of the artery, which creates favorable conditions for the penetration of cholesterol particles. Most of all this contributes to high blood pressure. Macrophages absorb lipoprotein molecules, turning into foam cells.
  2. The appearance of fibrous plaque. Further, growth factors are secreted due to damage to the endothelium and the accumulation of foam cells, which leads to increased division of smooth muscle cells and the production of connective tissue fibers (collagen and elastin). A stable plaque is formed with a thick and dense fibrous cover and a soft lipid core, narrowing the lumen of the vessel.
  3. The formation of complicated plaque. Progression of the process leads to an increase in the lipid core, the gradual thinning of the fibrous capsule, rupture and parietal thrombosis, which almost or completely clogs the lumen of the artery.

In the case of the internal carotid artery, the parietal thrombus comes off and clogs the smaller vessels (middle, anterior cerebral artery), causing an ischemic stroke.

The carotid arteries should ideally run smoothly. This is important because they carry oxygen and nutrients to the brain. However, over time they can narrow and become stiff. This happens due to the accumulation of atherosclerotic plaques on their walls.

The main reasons for the development of carotid arteriosclerosis are:

  1. Bad habits, that is, smoking tobacco and drinking alcohol.
  2. Arterial hypertension.
  3. Disorders of the organs of internal secretion.
  4. Various pathologies of fat metabolism (in the first place is obesity).
  5. Errors in the diet, violation of the diet prescribed by the doctor.
  6. Adverse genetic disposition.
  7. Frequent nervous stress.
  8. Hypodynamia, i.e. lack of physical activity.
  9. Some previously transmitted infectious pathologies.
  10. Disorders in the immune system (as well as some autoimmune pathologies).
  11. Diabetes. Such a disease adversely affects fat metabolism, as a result of which the body processes fats poorly.
  12. Elevated levels of “bad” cholesterol, triglycerides in the blood also contribute to the intense deposition of atherosclerotic plaques on the walls of the carotid arteries.

Typically, the above causes affect the body in a complex. Because of this, the likelihood of developing atherosclerosis is further increased.

In rare cases, the disease can develop due to carotid artery aneurysm or dysplasia.

As already noted, the most dangerous complication of atherosclerosis is stroke. There are such options for the development of the disease with clogged arteries with atherosclerotic plaques:

  • A progressive decrease in arterial blood flow to the brain.
  • Rupture of atherosclerotic plaques. However, they can spread with blood into smaller vessels. So there is a blockage of normal blood supply to a certain part of the brain, because of which it dies.
  • Blockage of blood flow by a blood clot (blood clot). This is due to the fact that platelets accumulate in the bloodstream due to rupture of plaques. They connect and form a blood clot. If it is large, it slows down the blood flow, which causes an apoplexy shock.

Just following a special diet is justified only in the early stages. In addition to switching to a sparing diet, it will be very useful to follow these recommendations:

  1. Eat up to 1 kg of cherries per day (it is better to drink them with milk).
  2. It is useful to eat black currants, plums, eggplant, watermelon.
  3. Sugar can be consumed, but only in very limited quantities.
  4. The menu should have more garlic and onions.
  5. Instead of regular black tea, you need to drink drinks from the leaves of blackcurrant, strawberries, blueberries, dried fruits.
  6. Walnuts, corn and olive oil help to remove “bad” cholesterol.
  7. Decoctions and teas from lemon balm, hawthorn normalize the pressure.

Among the preventive measures, it is necessary to highlight the following:

  • immediate cessation of smoking and drinking;
  • physical exercises;
  • dieting;
  • normalization of body weight;
  • monitoring of blood pressure and blood sugar.

To prevent such a pathology is much easier than to treat it. In many cases, surgical intervention is recommended to successfully restore normal circulation.

Carotid atherosclerosis develops very slowly. Usually from the moment of initial formations to the first symptoms, 20-30 years pass. During this time, the vessels are exposed to a variety of factors, each of which gradually stimulates the progression of the disease.

The main risk factors for developing atherosclerosis:

  • high pressure;
  • high cholesterol;
  • diabetes;
  • obesity;
  • sedentary lifestyle;
  • smoking;
  • elderly age;
  • hereditary predisposition.

Men under 75 years old are more prone to carotid atherosclerosis than women of a similar age. After 75 years, the risk of developing pathology is higher in women.

According to ICD-10, atherosclerosis of the carotid arteries is assigned to atherosclerotic heart diseases (group I25.1). In addition to it, it includes atheroma, sclerosis of the coronary arteries.

Cholesterol plaque forms on the vascular wall at a systematically elevated lipid level. Such a condition is provoked by such factors:

  • abuse of addictions;
  • endocrine pathologies;
  • excessive body weight;
  • interruptions in carbohydrate metabolism;
  • elevated blood pressure;
  • sedentary lifestyle;
  • viral and infectious pathologies;
  • psycho-emotional upheaval.

kontrol vesa - The causes and methods of treatment of plaques in the carotid arteryBy controlling his weight, a person will prevent such a dangerous disease.

It is much easier to prevent a disease than to deal with its consequences. Do exercises, monitor the diet, provide the body with the necessary vitamins and minerals is required from an early age. In young people, the body is much more susceptible and can cope with the problem without serious complications. To prevent the disease, you should adhere to medical recommendations, which include:

  • rejection of destructive addictions;
  • control of jumps in weight;
  • proper diet;
  • eradication of psycho-emotional situations;
  • the introduction of exercise;
  • timely medical examination.

Favorite Plaque Places

Most often, atherosclerotic plaques are located in the following places:

  • in the area of ​​bifurcation of the carotid artery, that is, where the common carotid is divided into external and internal;
  • at the mouth of the ICA – the initial segment of its branch from the NSA;
  • at the mouth of the vertebral arteries;
  • in the ICA siphon (the place of bending at its entrance to the skull).

This is due to the fact that in these places due to the roughness of the vessel, a turbulent (vortex) blood flow is created, which increases the likelihood of endothelial damage.

What types of disease are there?

NameDescription
Non-stenoticBlockage less than 50%
Lifestyle adjustments are enough to cure
StenosingPlaque occupies more than 60% of the artery
The clinical picture is actively manifested
Conservative and surgical therapy
MultifocalThe body is undergoing major changes
Medication does not bring results, and surgical intervention is dangerous to human life

Symptoms and complaints of the patient

Clinical symptoms of atherosclerosis of the neck vessels occur when the lumen of the artery is narrowed by more than 50%, and the brain begins to experience oxygen starvation. As practice shows, there are patients with a greater degree of stenosis who do not show any complaints and feel completely healthy. Prolonged insufficiency of the blood supply to the brain is called chronic ischemia or dyscirculatory encephalopathy. Her symptoms:

  • rapid onset of fatigue, decreased physical and intellectual performance;
  • memory impairment and mental degradation;
  • loss of critical thinking;
  • frequent mood swings;
  • sleep disturbance – drowsiness during the day, insomnia at night;
  • dizziness, headache, tinnitus.
  • transient ischemic attack;
  • ischemic stroke (stroke).

Transient ischemic attack (TIA) is a sharp deterioration in blood circulation in a particular area of ​​the brain. She is a pre-stroke condition. Symptoms

  • dizziness;
  • imbalance, unsteady gait;
  • transient blindness in 1 eye;
  • speech impairment;
  • numbness, a feeling of weakness in one half of the face, arm, leg, etc.

In ischemic stroke, almost the same picture is observed, but more severe, with a risk of death, complete paralysis of one half of the body or an epileptic seizure can also occur. The main difference between TIA and stroke is that its symptoms completely disappear after 24 hours, and in the case of stroke, they remain for a long time, and also require specialized measures. If TIA is not diagnosed in time and qualified treatment is not provided, then it can go into a stroke.

Therapies

Treatment of atherosclerosis of the carotid arteries is a complex task. The method of treatment directly depends on the degree of vascular stenosis and the clinical picture, namely the presence of discirculatory encephalopathy and transient ischemic attacks and strokes. With a slight narrowing of the ICA and minor symptoms, the absence of acute conditions, you can do only with drug therapy:

  1. Statins (Atorvastatin, Rosuvastatin) – the main type of drugs that slow the progression of atherosclerosis. They lower the concentration of cholesterol in the blood. The target level of low density lipoproteins is less than 1,8 mmol/L.
  2. Acetylsalicylic acid prevents the formation of a blood clot on an atherosclerotic plaque. If the patient has a peptic ulcer of the stomach or duodenum, Clopidogrel is preferably prescribed.
  3. Means for lowering blood pressure. The patient needs to maintain blood pressure figures at a certain level (lt; 140/90 mmHg Art., and with diabetes lt; 130/80 mmHg Art.). For patients with atherosclerosis from all pharmacological groups, ACE inhibitors (Perindopril, Lisinopril), sartans (Losartan, Valsartan) or calcium antagonists (Amlodipine) are preferred.
  4. Medicines for diabetes. To stabilize the level of glucose in the blood, sugar-lowering drugs (Metformin, Glibenclamide) or insulin injections are prescribed.

What surgical methods of treatment are applicable for atherosclerosis of the neck vessels? There are 3 main indications for their use:

  • stenosis of more than 70% with an absolutely asymptomatic course;
  • stenosis of more than 60% with discirculatory encephalopathy;
  • stenosis of more than 50% if there were acute conditions (TIA or ischemic stroke).

There are the following methods of surgical intervention for atherosclerosis of the ICA, each of which has its own subtleties and nuances:

  • carotid endarterectomy – classic and eversion;
  • stenting.

In classical endarterectomy, surgery is performed under general anesthesia. After dissection of the skin and subcutaneous fat, the carotid artery in the bifurcation area is secreted. Then, in order to avoid massive bleeding, the OCA is pinched. A longitudinal section of the ICA is performed, the atherosclerotic plaque is carefully separated from the intima with a spatula.

Shematichnoe izobrazhenie raspolozhenija sonnoj arterii - The causes and methods of treatment of plaques in the carotid artery

The hole is closed with a patch of a large saphenous vein or synthetic material. Its installation is preferable to simple suturing, as it has a lower incidence of restenosis. This method is used for plaque lengths greater than 2 cm.

Eversion endrecterectomy is distinguished by the fact that it does not involve a longitudinal section of the ICA, but its complete separation from the OSA, a gradual inversion and purification of cholesterol plaque. The advantage of this method is less deformation and a lower risk of arterial restenosis. However, it can be used only with a small extent of damage (up to 1,5-2 cm).

The third method is endovascular stenting. This operation is performed under local anesthesia. A catheter with a balloon is inserted through a puncture in the femoral artery. Under the control of fluoroscopy, he gets to the site of narrowing in the carotid artery. The balloon is inflated, then with the help of another catheter a metal stent (wire cylinder) is installed, which holds the vessel in the expanded state.

!  If the upper pressure is low and the lower is normal

Specialist Tips: Lifestyle Changes

In addition to medical and surgical treatment, lifestyle correction plays an important role. I always recommend that my patients give up smoking, exercise regularly, and make changes to their diet (eat more vegetables, fruits, and fish). Patients with diabetes need to periodically donate blood for glycated hemoglobin, follow a low-carb diet, visit an endocrinologist and take prescribed medications to lower blood sugar.

Principles of therapy

It should be noted that only complex treatment can normalize the state of arteries. And you need to start it as soon as possible.

Treatment with folk remedies, as a rule, does not bring the expected results. In this case, valuable time is lost, and instead of relief, a pronounced aggravation of the pathology occurs.

First of all, you need to adjust the power. Diet prohibits the use of foods such as:

  • smoked dishes;
  • fat;
  • fatty foods;
  • soda;
  • alcohol;
  • coffee and strong tea;
  • bread from premium flour;
  • sweets.

The menu should have more fresh vegetables, fruits, steamed dishes.

Mandatory is drug therapy:

  1. Medications are used that relieve the symptoms of atherosclerosis.
  2. Typically, the patient is prescribed drugs that lower blood pressure. The need for their appointment must be weighed.
  3. It is very important to take drugs to lower blood cholesterol. They help reduce the intensity of deposition of atherosclerotic plaques on the walls of blood vessels.
  4. At the same time, drugs are also used to normalize metabolism and strengthen blood vessels.
  5. Sometimes a doctor may prescribe a small amount of acetylsalicylic acid to the patient to prevent the formation of blood clots. Such treatment should be carried out for a long time. Constant intake of aspirin contributes to some normalization of blood circulation and reduces the risk of dangerous complications.

Self-treatment of atherosclerosis is strictly contraindicated! It can lead to extremely dangerous consequences.

Specialist Tips: Lifestyle Changes

In addition to medical and surgical treatment, lifestyle correction plays an important role. I always recommend that my patients give up smoking, exercise regularly, and make changes to their diet (eat more vegetables, fruits, and fish). Patients with diabetes need to periodically donate blood for glycated hemoglobin, follow a low-carb diet, visit an endocrinologist and take prescribed medications to lower blood sugar.

Surgical intervention

If the above conservative methods of treatment do not bring the expected results, then the question of surgical treatment is considered. For this, the doctor can prescribe such types of operations as:

  1. Carotid endarterectomy. It is usually performed using general anesthesia. After the doctor makes a small incision, plaque is removed.
  2. Balloon angioplasty is performed in cases where endarterectomy is contraindicated. Such an operation is also justified if the atherosclerotic plaque is in a difficult place. This intervention can be carried out under local anesthesia.
  3. Stenting is that an artery is punctured in the thigh or shoulder. A stent is then inserted into the lumen of the carotid artery – a small metal apparatus. It expands the lumen of the vessel and allows for normal blood flow.

Angioplasty is a relatively new treatment today. Its effect on blood vessels and on the body as a whole is still the subject of thorough research. However, in patients with a high risk of complications, these types of operations prove their effectiveness.

Stenosing and non-stenotic carotid arteriosclerosis: difference in symptoms and treatment

In fact, these are only different stages of one disease. Non-stenotic atherosclerosis is a condition in which a plaque occupies less than 50% of the lumen of an artery. As a rule, he does not manifest himself in any way. It can be suspected by weak systolic murmur in the carotid arteries. In some cases, drug therapy (statins, antihypertensive drugs, etc.) is needed. A detailed description of the clinical presentation and treatment of stenosing atherosclerosis is given above.

Case study: Atherosclerosis of the vertebral arteries

A 57-year-old man began to complain of slight dizziness, hearing loss. Relatives told him that his gait had become uneven. A week ago, when he sharply turned his head, there was a loss of a sense of balance and a fall, after which the patient went to the doctor.

When questioned, it turned out that he suffers from hypertension and type 2 diabetes. He is taking the prescribed medicine irregularly. When measuring blood pressure, the tonometer showed a value of 165/95 mm RT. Art. Suspecting atherosclerotic lesions of the vertebral arteries, I prescribed a duplex scan, during which stenosis of the right PA to 65%, narrowing of the left PA to 40% were detected. I sent the patient for surgical treatment.

An endarterectomy of the right PA was performed. Also, the patient is prescribed drug therapy – Rosuvastatin, Acetylsalicylic acid, Perindopril, Metformin. The patient noted a significant improvement – the dizziness stopped, the sense of balance returned.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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