Carotid artery stenosis warning
Every organ in the body is supplied with oxygen and nutrients through blood vessels. Sudden death occurs when the blood vessels in the heart are blocked, and fatal sequelae are left when blood vessels in the brain are blocked. The current blood vessel of interest is the carotid artery. It is an artery that passes through the neck and is located 3 cm to the left and right of the neck. It is an important blood vessel through which 80% of the blood from the heart to the brain passes. However, the carotid artery is one of the blood vessels that are prone to atherosclerosis. As eating habits become westernized and we enter an aging society, the number of patients suffering from stenosis, in which the carotid artery is narrowed and hardened, has increased significantly. Last year, more than 110,000 people were treated for carotid artery stenosis.
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Even if half of a blood vessel is blocked, subjective symptoms are minimal
Carotid artery stenosis is scary because it is directly related to brain health. When fat accumulates in the blood vessels of the carotid artery and muscle cells proliferate, blood flow to the brain becomes insufficient, which can lead to cerebral infarction. Also, unstable blood clots accumulated in the carotid artery fall off and block blood vessels in the brain, causing cerebral infarction to progress. Professor Woo Ho-geol of the Department of Neurology at Kyung Hee University Hospital said, “Carotid artery stenosis is not only a problem of narrowing of blood vessels, but also can cause a stroke by blocking blood vessels in the brain if a blood clot breaks off.” warned. Moderate stenosis with more than 50% narrowing of the carotid artery in the population aged 65 years or older is estimated at 5-10%, and severe stenosis with more than 80% causing a lot of changes in blood flow is estimated at regarding 1%.
In particular, due to the thickening and narrowing of the blood vessel walls, the decrease in blood flow becomes chronic, which can cause dementia. According to a paper published in the international academic journal ‘Stroke’ in 2015, the risk of developing mild cognitive impairment and dementia increased by 25% 5 years following the thickness of the carotid artery wall increased by 0.1 mm. The problem is that in the case of the carotid artery, even if half of the blood vessels are blocked, there are no special subjective symptoms. If you have a family history of cerebral infarction, diabetes, high blood pressure, dyslipidemia, or vascular disease in the heart or limbs, it is recommended that you perform regular carotid artery ultrasound from the age of 40 to 50. Professor Woo said, “If you experience sudden blackness in front of your eyes, sudden loss of strength in your limbs, or symptoms of dizziness or facial paralysis, it’s good to get an ultrasound scan without delay.” ”he said.
The main goal of treatment for carotid artery stenosis is to prevent cerebral infarction. Since the risk of cerebral infarction varies depending on the degree of stenosis and whether symptoms occur, the risk of stroke is first determined through ultrasonography. In case of cerebral infarction or transient cerebral ischemia due to carotid artery stenosis within 6 months, active treatment is recommended. Typical examples include carotid endarterectomy, in which the carotid artery is incised and the fatty tissue blocking the blood vessel is removed and then sutured, and stent implantation, which widens the blood vessel by inserting a stent inside the blood vessel.
These days, there are quite a few cases of accidental discovery during health checkups. It is questionable whether surgery or treatment is necessary in the case of asymptomatic stenosis. Experts prioritize risk factor control when there are no symptoms and the degree of carotid artery stenosis is less than 50%. The incidence of cerebral infarction in asymptomatic stenosis is as low as 0.3%. If you are a smoker, it is okay to quit smoking, control your blood pressure, blood sugar and cholesterol levels, and administer medication if necessary. In addition, regular follow-up checks are performed to make sure that the severity of the stricture is not getting worse. However, even in asymptomatic patients, if the degree of stenosis is over 70%, surgery or treatment can be considered considering age or other vascular conditions.
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I like walking briskly for at least 30 minutes a day
The status of atherosclerotic plaques (plaques) also serves as a high-risk indicator. If many microembolic signals are observed on cerebral blood flow ultrasonography, fine clots fall off and go up to the cerebral vessels, suggesting that the clots accumulated in the carotid artery are in an unstable state, and appropriate treatment should be followed. A study showed that 15.6% of patients with a large number of microembolic signals had cerebral infarction within one year.
In addition, if the blood vessels become narrower, if the atherosclerotic plaque is bumpy or the surface is dug like an ulcer, if the inside of the atherosclerotic plaque is accompanied by bleeding or if the fat is large, a thrombus may block the carotid artery or come off and block the cerebral blood vessel. I think the risk is high. Professor Woo emphasized, “Since restenosis may occur even following surgery or procedure, it is more important than anything else to continuously manage risk factors.”
The key to managing risk factors is to control hypertension, diabetes, and dyslipidemia. For treatment purposes, you should maintain a healthy diet and exercise. A Mediterranean diet consisting of fresh vegetables and fruits, low-fat dairy products, fish, and vegetable fats is recommended. For exercise, it is better to walk fast or run slowly for 30 minutes a day, 3 times a week or more rather than strenuous events. I’m out of breath and sweaty, but it’s okay to be able to have a conversation with the person next to me.
Sunyeong Kim (kim.sunyeong@joongang.co.kr)
