The symptoms
Clogged carotid arteries often remain asymptomatic or asymptomatic for a long time, so that they can go undetected for a while. Only after a certain degree of stenosis do the first symptoms appear, which are based on reduced or insufficient blood flow to the cerebral arteries. Typical complaints that can make clogged carotid arteries noticeable are, for example, visual disturbances such as double vision or even complete loss of the visual field (amaurosis fugax), speech disorders, headaches, dizziness or even paralysis.
These symptoms come on very suddenly and in attacks, in the best case they subside after a few minutes to hours. If this is the case, one speaks of a TIA, a so-called transitory ischemic attack, a kind of “mini-stroke“.If the symptoms persist over a longer period of time or only partially or not at all regress, one speaks of a stroke (apoplexy). Within the scope of a blocked carotid artery, sensory disturbances can occur.
Not enough blood and therefore not enough oxygen is pumped into the brain. This can result in symptoms of failure and sensory disturbances. These can manifest themselves in the form of pain.
However, pain occurs in rare cases and usually appears in an advanced stage. However, pain after surgery to remove arteriosclerotic plaques is relatively common. After a few days, however, they subside again.
The Therapy
The conservative treatment of congested carotid arteries is understood to be all therapeutic measures that can be carried out instead of surgery. Once the arteries are blocked or narrowed, this condition cannot be reversed without surgery. Only the further progression of the narrowing can be prevented by eliminating all risk factors.
These include reducing overweight, reducing stress and stopping smoking. On the other hand, secondary diseases such as high blood pressure must be well treated so that the blood pressure is set to normal values. (s. Blood high pressure lower) Same applies also to the sugar values in the blood with diabetes mellitus.
(see Therapy of diabetes) In addition, the risk of a stroke due to detached plaques can be reduced by taking medication-based blood thinners to prevent the formation of clogged blood clots. The use of certain medications for clogged carotid arteries is part of conservative therapy and is used before and/or after any surgical treatment to reduce the risk of stroke. The most important drug therapy is the use of blood-thinning agents such as acetylsalicylic acid (ASA), which prevents the formation of blood clots.
Furthermore, various drugs can be given to adjust other risk factors, such as sugar-lowering, blood pressure-lowering and blood-fat-lowering drugs. An overview of these medications can be found under Medications for Diabetes and Medications for Hypertension. However, medication alone is only useful if the degree of stenosis is still asymptomatic and is mainly used to prevent further progression of the stenosis.
If a certain degree of stenosis is exceeded or the blocked carotid artery becomes symptomatic, the therapy must be extended to include surgery. Surgery for congested carotid arteries is always necessary if the stenosis has progressed to such an extent that the risk of suffering a transient ischemic attack or stroke is very high, or if the affected person has already become symptomatic with a stroke. Surgery is generally recommended for all symptomatic obstructed carotid arteries and for asymptomatic stenoses >70%.
There are two main surgical techniques that can be used: Firstly, it is possible to remove the stenosis, i.e. the calcification or plaque – in doing so, the affected vessel is opened and the plaque is peeled out. This procedure is called thrombendateriectomy (TEA). On the other hand, there is the possibility of expanding the blocked/constricted area using a balloon catheter and, if necessary, even inserting a stent to keep the constriction permanently open or further open.
This is called carotid angioplasty. The insertion of a stent – a vascular support made of metal wire – in the course of carotid angioplasty is the most frequently performed surgical procedure nowadays. As a rule, the patient is given a local anaesthetic under which a tube system (catheter) is inserted into the body via the inguinal artery.
Once the catheter is advanced to the narrowed carotid artery, the narrowing is widened by means of a balloon and then lined with a stent. Either metal-coated stents or so-called drug-eluting stents can be used, whereby the latter are coated with drugs that prevent cell renewal and thus overgrowth of the stent with vascular cells. Depending on the stent material used, the time required for drug-eluting blood thinning after surgery varies. The most important risk associated with carotid stenosis surgery is the loosening of plaque material, which clogs downstream small vessels and leads to stroke symptoms.During surgery, whether TEA or carotid angioplasty is performed, work is performed in the narrowed area, so there is an inevitable risk of material loosening.