2023-06-04 20:50:55
Definition: what is a blocked carotid artery (carotid stenosis)?
Carotid stenosis refers to a narrowing of the tunnel lumen of a carotid artery. As a reminder, the carotid is one of the main arteries of the neck which brings blood from the heart to the brain. Carotid stenosis is the consequence of atherosclerosis, that is to say the formation of atherosclerotic plaques on the wall of the arteries. These plaques are mostly made up of fat and calcium deposits. Carotid stenosis increases the risk of stroke due to blockage of the carotid artery (ischemic stroke).
Carotid artery: what is it? Where is she ?
The carotid arteries are found on both sides of the neck and head. They help bring blood from the heart to the brain. We distinguish :
- the common carotid arteryorprimitive gauche which arises from the aorta;
- the right common or primitive carotid artery which arises from the brachiocephalic arterial trunk which itself arises from the aortic arch.
These two primitive carotids each divide into a internal carotid artery which vascularizes the brain and the eye and in a external carotid artery which irrigates the face and neck.
A blockage of a carotid artery therefore leads to suspension of blood flow to the brain which quickly suffers from a lack of oxygen and the nutrients necessary for its proper functioning: this is the stroke. This medical condition can lead to irreversible brain damage.
Causes: why does the carotid get blocked?
The most common cause of carotid obstruction is atherosclerosis. Stroke occurs by ischemia or embolism.
The formation of a carotid atheroma
The carotid is a classic localization of atheroma (consisting of infiltration of the artery wall (intima) by lipids, calcium deposits and other types of cells).
THE risk factors are those of atheroma: family history, male sex, advanced age, smoking, arterial hypertension, diabetes, dyslipidemia (hypercholesterolemia and/or hypertriglyceridemia) and chronic inflammation.
Another possible cause of carotid atheroma is a history of radiation therapy to the neck area, in particular in the context of the treatment of cancer of the upper aerodigestive tract (VADS) or lymphoma. The supposed mechanism is an “acceleration” of atheroma formation.
Most often, the stenosis is located at the level of the carotid bifurcation (terminal part of the common carotid) or at the level of the initial part of the internal carotid.
Embolism or ischemia
- In the event of atherosclerosis, fragments of the atherosclerotic plaque or blood clots may break off and be released into the bloodstream at the risk of clogging the carotid artery (embolism).
- In addition, the reduction in the lumen of the carotid artery leads to a reduction in blood flow to the brain, which then lacks oxygen (ischemia).
Both of these situations can lead to stroke.
What are the risks of a clogged carotid artery?
The main risk of carotid stenosis is ischemic stroke or cerebral infarction (sudden stop of blood circulation inside the brain). Carotid stenosis is responsible for approximately 40% of ischemic strokes.
Strokes are the second leading cause of death worldwide and the leading cause of acquired physical disability. They represent approximately 130,000 new cases each year in France (including 25% among those under 65). Mortality at 6 months is regarding 30 to 40%.
Carotid blocked at more than 70% and risk of stroke
Tight carotid stenoses with a voluminous atheroma plaque are the most at risk of causing a stroke. There is a major risk of stroke when the stenosis obstructs more than 70% of the artery (assessment by echo-doppler) and that the patient is symptomatic. In this case, preventive surgery can be performed to unclog the carotid artery and reduce the risk of stroke.
What are the symptoms of blocked carotid artery?
A clogged carotid artery can give rise to symptoms in the event of a stroke. It exists four types of ischemic stroke :
– clumsiness of the hand interfering with writing or causing an object to drop;
– gray veil descending in front of one eye;
– difficulty speaking…
Be careful, these AIT should not be taken lightly and should encourage you to consult a doctor. They can alter the proper functioning of the brain and be the harbingers of a major stroke.
- Regressive ischemic stroke whose manifestations last more than 24 hours and less than three weeks. These strokes leave no visible sequelae, but often correspond to the destruction of a small part of the brain. This type of stroke can leave some discreet sequelae (slight discomfort when writing or speaking, for example).
- Major ischemic stroke whose symptoms and complications are significant. The sequelae can be very disabling and permanent: inability to speak or move without help, for example. Death is a possible outcome. Signs of a major stroke are:
– a mouth deformity ;
– a weakness or sudden numbness on only one side of the face : impossibility of smiling, the lip is drooping on one side;
– a sudden loss of strength or one numbness in the arm or leg (paraesthesia);
– a speech difficultyor understanding.
These signs are reversible or fixed.
In the presence of any of these signs, call 15 or 112 (European emergency number) from a landline or mobile phone (even blocked or without credit).
If certain recurring signs worry you, talk to your doctor.
Examinations: how to know if the carotid artery is clogged?
Carotid stenosis can be diagnosed in the context of a CVA or a TIA either incidentally during cardiovascular examinations or in front of a carotid murmur on auscultation.
The first screening test is thedoppler ultrasound of the carotid. It can be supplemented by a angio-MRI or one CT angiography and in some cases a arteriography.
Blocked carotid: can we live with it? when to operate?
Carotid stenosis is very common following 60 years. It is possible to live with this condition which generally remains asymptomatic for a long time. Nevertheless, when the carotid stenosis is significant, symptomatic and the atheroma voluminous, it is preferable to set up a stroke prevention treatment.
Treatment: how to treat a clogged carotid artery?
The management of carotid stenosis can go through the simple taking of medication and the revision of lifestyle habits. However, when this pathology becomes significant and symptomatic, surgical intervention is necessary.
Medications and correction of risk factors
When carotid artery stenosis is less than 50%, medical treatment alone is recommended to reduce the risk of stroke. Three types of medication will then be prescribed together:
- treatment with an antiplatelet agent (Plavix or aspirin);
- a statin;
- an enzyme converting inhibitor (or a beta blocker in some cases).
In addition, the correction of cardiovascular risk factors is essential: treatment of arterial hypertension, reduction of cholesterol in the blood, smoking cessation, balancing of diabetes, practice of physical activity, balanced diet, etc.
Intervention in surgery
Surgery is indicated when the carotid stenosis becomes symptomatic (signs of TIA, stroke or carotid murmur) or when it is asymptomatic but very tight.
According to the recommendations of the French National Authority for Health (HAS), when the obstruction rate of the stenosis is greater than or equal to 70% of the diameter of the arteryit requires surgery, often recommended in addition to medical treatment (source 1).
For stenoses with 50 to 69% obstruction, the decision for surgery is discussed by the medical team depending on the patient’s profile and the type of atheromatous plaque.
When it is performed following a CVA/AIT, the intervention is performed within two weeks following the vascular incident.
The operation performed is calledcarotid endarterectomy. Its objective is to neutralize the atherosclerotic plaque at the blocked carotid artery.
Locoregional anesthesia has taken a growing place in this surgical indication traditionally performed under general anesthesia. It takes on average 1h30 of intervention in the operating room. The surgeon incises the skin and the underlying tissues until reaching the carotid bifurcation. Once the carotid artery is open, he removes the atheroma plaque, taking care to remove all the impurities. Once the artery has been cleaned, it is closed either directly or with a fabric patch, which restores it to its original size. The underskin and the skin are closed over a small Redon drain. There are other operative techniques for the same purpose (carotid bypass, eversion endarterectomy).
Carotid endarterectomy reduces the risk of subsequent or recurrent stroke but carries a risk of complications immediately before, following, and during the operation, including disabling stroke and death.
In some cases, the surgeon may opt for placement of a stent in order to support the artery, but this choice is not recommended in first intention in France.
Hospitalization for a few days is required following the operation. Medical supervision is essential therefollowing.
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