Carotid stenosis is the narrowing of the carotid artery, which supplies oxygen and nutrients to the brain. The condition is caused by deposits in the artery. Carotid stenosis is one of the most common causes of stroke.
What is carotid stenosis?
Smoking and little exercise are huge contributors to stroke. Carotid stenosis is a narrowing of the carotid artery. Stenosis means “narrowing” and carotid stands for carotid artery . This is the artery that runs on either side of the neck and branches into arteria carotis interna (internal carotid artery) and arteria carotis externa (external carotid artery). The internal artery runs to the brain and supplies it with oxygen and nutrients; the external, on the other hand, is responsible for supplying the face. When we speak of carotid stenosis, we are referring to the internal artery. The narrowing is caused by deposits in the vessel; they obstruct the blood flow and thus reduce the blood supply to the brain. In case of carotid stenosis, there is always a risk of stroke, because deposits can detach, which are then transported to the brain and cause a cerebral infarction. It is believed that approximately 60% of all strokes are caused by carotid stenosis.
Causes
The cause of carotid stenosis is usually arteriosclerosis (calcification of the vessels). Here, substances called arteriosclerotic plaques are deposited in the vessels. They clog the arteries so that the blood can no longer flow freely. As a result of the reduced blood flow, too little oxygen and nutrients are transported, which leads to an undersupply at the corresponding organ. If the carotid artery is affected, this leads to a reduced supply to the brain. The cause of arteriosclerosis, in turn, is usually high blood pressure, unhealthy high-fat diet, little exercise and smoking. Most often, patients with peripheral arterial disease (PAVK) develop carotid stenosis. In this disease, the vessels of the extremities in particular, i.e. the arms and legs, calcify. Carotid stenosis also occurs in patients with coronary artery disease (CAD), in which the vessels in the heart calcify, but less frequently in comparison.
Symptoms, complaints, and signs
Carotid stenosis is often asymptomatic in the early stages. In the later stages, symptoms include speech disorders, paralysis, and nerve disturbances in the face and limbs. In addition, visual disturbances and dizziness may develop. In the field of vision, there are disturbances such as blurred vision, double vision, or visual field defects in which the patient has no perception in the left or right part of the visual field. The visual disturbances last from a few seconds to minutes. Furthermore, speech disorders, hearing difficulties and swallowing difficulties may occur. At the beginning, the symptoms usually occur only for a short time and quickly subside. If no treatment is given, a stroke can occur. A stroke manifests itself as permanent visual, hearing and speech impairments, paralysis and neurological damage. Those affected can usually move only to a limited extent and suffer from reduced mental capacity. In addition, flaccid facial muscles may be noticed. Depending on the severity of the carotid stenosis, spasms, circulatory problems and other secondary symptoms may also develop. The carotid stenosis itself occurs quite suddenly and is over after a few minutes. In mild cases, only imperceptible deficits remain; in severe cases, stroke can be fatal.
Diagnosis and course
In the early stages, carotid stenosis usually shows no symptoms. Especially in older people, carotid stenosis is often present and goes unnoticed. This is referred to as asymptomatic carotid stenosis or stage I stenosis. Symptoms do not appear until stage II, as the artery is now already more narrowed. This can lead to visual disturbances, short-term paralysis, dizziness or speech disorders. In stage II, the symptoms are temporary, i.e. they disappear again, usually within 24 hours. If it takes longer than a day for the symptoms to disappear again, this is referred to as a “little stroke”. Stage III is defined as carotid stenosis with a freshly diagnosed stroke.Stage IV is what doctors call the condition after a stroke with permanent damage. The suspicion of the diagnosis of carotid stenosis initially arises from the failure symptoms. However, in this condition the stenosis is already advanced. By means of ultrasound, deposits in the artery can be made visible. Today, special duplex ultrasonography is used for diagnosis, which can also be used to detect the extent of carotid stenosis. Another examination method is angiography, in which, after prior injection of a contrast agent, the arteries are imaged by X-ray or computed tomography (CT) and carotid stenosis can be detected.
Complications
Carotid artery stenosis can cause various sequelae and complications. In most cases, however, this narrowing leads to a stroke, which in the worst case can also be associated with the death of the patient. For this reason, carotid stenosis should be examined and treated by a physician in any case. Affected persons can suffer primarily from paralysis, which can occur in various regions of the body. Other disturbances of sensitivity or sensory disturbances can also limit the patient’s quality of life. Furthermore, the patient may experience shortness of breath and thus a loss of consciousness. It is not uncommon for severe headaches and speech disorders to occur. Coordination and concentration are also limited and reduced by carotid stenosis. Patients may continue to suffer from depression and other saxic moods or symptoms. Carotid stenosis can be treated by surgery and with the help of medication. No particular complications occur. However, life expectancy is reduced by carotid stenosis in most cases. The affected person must pay attention to a healthy diet and a general healthy lifestyle.
When should you see a doctor?
If visual disturbances, dizziness, speech problems, or other signs of carotid stenosis occur, a doctor should be consulted immediately. If symptoms occur for more than a day at a time, a physician must be consulted. Medical advice is also required if the complaints increase the risk of accidents or have already led to falls in the past. Should a stroke occur, the emergency physician must be alerted immediately. The patient then requires comprehensive treatment in hospital. In principle, carotid stenosis must be clarified as quickly as possible. If the narrowing is not treated, a stroke may result. Therefore, a doctor should be consulted at the first sign of the disease. Elderly people and stroke patients are particularly susceptible to the development of carotid stenosis and should see a doctor immediately if they experience any of the symptoms mentioned above. Further medical examinations are necessary if the symptoms do not subside or suddenly increase in intensity. Affected individuals should contact their family physician or an internist.
Treatment and therapy
Treatment or therapy for stroke should be initiated as soon as possible. The longer the brain is without oxygen, the more nerve cells die and the brain cannot be healed. If a stroke occurs, it should be reported immediately to an emergency physician. Carotid stenosis from stage II is usually treated surgically. Patients with a stenosis that is only in stage I receive medication to inhibit the formation of blood platelets and to lower blood lipids and blood pressure. Furthermore, statins are administered, which counteract the formation of deposits and thus slow down the development of arteriosclerosis. Surgical therapy usually consists of thromboendarterectomy (TEA). In this method, the affected artery is opened lengthwise at the narrowed site and the deposit material is peeled out. This procedure can take place under general anesthesia, but also with local anesthesia. A variant of TEA is eversion TEA, in which the calcified part of the artery is cut out, freed from calcium deposits by a special procedure, and then reinserted. Another possible surgical procedure is carotid angioplasty, in which the narrowing is widened by means of an inserted balloon and a stent (vascular support) is inserted to keep the artery open.However, this method is not yet routinely used for carotid stenosis; the classic procedure is TEA.
Outlook and prognosis
Carotid artery stenosis can be life-threatening. In the worst case, the affected person loses his or her life in an acute situation. Likewise, lifelong physical impairments are possible, leading to a reduction in quality of life. These are usually irreparable and can lead to a psychological secondary illness due to the emotional stress. If an unhealthy lifestyle is the cause of carotid artery disease, lifestyle changes must be made as soon as possible. Otherwise, the prognosis is unfavorable, as it will lead to the demise of the affected person without medical care. The diet must be changed and the consumption of harmful substances such as alcohol or nicotine must be completely avoided. In an advanced stage of the disease, the affected person needs surgical intervention to increase his chances of survival and prevent a stroke. The treatment is associated with various risks and can lead to complications. The management of everyday life must be altered in the case of carotid artery stenosis. The physical resilience is reduced and leads to a limitation in performing usual physical tasks. This leads to a decrease in well-being and can worsen the overall situation. Sufferers of carotid artery stenosis are permanently at risk of an outbreak of an acute health situation. When a sudden deterioration occurs, intensive medical care is required as soon as possible.
Prevention
One can prevent carotid stenosis by avoiding the risk factors for atherosclerosis. It is possible to effectively prevent carotid stenosis with a healthy balanced diet, adequate exercise, alcohol only in moderation, and avoidance of nicotine.
Follow-up
Carotid stenosis is a serious disease that must be examined and treated by a doctor in any case. In this regard, the measures of a follow-up are relatively limited in most cases, so that the affected person should first and foremost carry out a quick diagnosis. A physician should be contacted at the first signs and symptoms of the disease, and early diagnosis usually always has a very positive effect on the further course of the disease. Treatment is carried out by taking various medications. The correct dosage must always be observed in order to permanently alleviate the symptoms. Likewise, a healthy lifestyle with a healthy diet usually has a very positive effect on the further course of carotid stenosis, so that the affected person should pay attention to a diet plan from a doctor. If the carotid stenosis is treated by a surgical intervention, the affected person should in any case rest and take care of his body after such an intervention. Possibly, the life expectancy of the affected person is reduced due to this disease, and the further course depends greatly on the time of diagnosis.
This is what you can do yourself
The measures to be taken in the case of carotid stenosis depend on the stage of the disease. Treatment is not always needed in the first stage. Patients need to watch for any symptoms and see a doctor regularly to ensure that no complications occur. Accompanying this, a change in lifestyle may be useful. Depending on the trigger underlying the symptoms, any excess weight must be reduced, stimulants avoided and/or regular exercise taken. In the case of hereditary diseases, the most important measure is to monitor the symptoms. Carotid stenosis in the second stage is usually treated surgically. After such an operation, the affected person initially needs rest and sparing. Accompanying medication is prescribed to lower blood pressure and blood lipids. In some cases, the medication can be supplemented with natural remedies. Painkillers and preparations that dilate the blood vessels have proved particularly effective. The use of alternative remedies should first be discussed with the physician. Carotid stenosis in the third stage requires immediate emergency medical attention. If a stroke has already occurred, first aid must be given until the ambulance service arrives.
