CAROTID ARTERY DISEASE
1. ATHEROSCLEROSIS
- Carotid arteries in the neck supply most of the blood to the brain.
- These arteries can be affected by atherosclerosis that leads to progressive narrowing (stenosis), and in some cases, complete blockage (occlusion).
- In occlusion, attempting to reopen the blocked artery isn’t beneficial, so treatment focuses on the arteries that are only partially blocked.
- Atherosclerosis of the carotid arteries develops when fatty deposits or plaque clogs them.
- The buildup blocks the blood supply to the brain and increases risk of stroke.
- In its early stages, carotid artery disease has no symptoms.
- As it progresses, it deprives the brain of blood and leads to a transient ischemic attack (TIA).
- The symptoms of TIA include
- sudden numbness or weakness on the face, arm or leg, typically on one side of the body
- slurred, garbled speech or difficulty understanding others
- sudden blindness in one eye.
- Although a TIA produces symptoms similar to a stroke, it usually lasts a few minutes and causes no permanent damage, but is a warning of an impending stroke.
2. CAROTID ARTERY STENTING
- In moderate cases, carotid artery disease improves with quitting smoking, losing weight, eating healthy food, and exercising regularly with medication.
- But, in severe cases, where the carotid artery is blocked 70 percent, the blockage must be removed and the artery opened.
- Carotid artery stenting is a safe, effective option.
- A tiny balloon is threaded by catheter to the area where the artery is clogged.
- The balloon is inflated to widen the artery and a small wire-mesh stent inserted to keep the artery from narrowing again.
- This is low risk in most healthy people, prevents strokes and has lasting benefit.
3. ROTABLATION
- Rotablation is a technological advancement which has immensely helped in improving the results of angioplasty.
- Over time, plaque – a fatty substance made up of cholesterol, calcium and other materials, builds up in our arteries.
- When a heart artery is completely blocked by a plaque, it can cause heart attack.
- If a plaque is soft enough, angioplasty can be easily performed by opening the block with a balloon first and then placing a stent (kind of spring) across the block and opening the stent completely so as to keep the vessel fully open.
- But, what if the plaque is too hard for angioplasty?
- As calcium builds up in artery walls, plaque can become extremely rigid and hard or even too hard for an angioplasty balloon to stretch the artery open.
- That is where rotablation, or rotational atherectomy, comes in.
- A device called rotablator was invented, which is a tiny drill with a burr on the end that is coated in diamond dust.
- The rotablator drills through calcific plaque breaking it up into tiny pieces and forming a smooth tunnel through the plaque.
- These tiny pieces are small and safe enough to be picked up by the blood stream.
- Because of the smooth tunnel formed by the rotablator through the block, it is easily possible to take the balloon and then the stent to the block, place the stent across the block after stretching open the block with the balloon and then easily open the balloon to its fullest – thus optimizing and perfecting the result of angioplasty.
- It is because of the rotablator that it is possible to avoid bypass surgery in patients who have complicated open blockages.
4. CIRCLE OF WILLIS
- But if a carotid artery is completely blocked, risk of stenting usually outweighs the benefit.
- Fortunately, the brain can use alternative routes to provide blood to the area of the brain supplied by the blocked artery.
- A network of blood vessels at the base of the brain, called the circle of Willis, can supply the necessary blood flow.
- Many people function normally with one completely blocked carotid artery, provided they haven’t had a disabling stroke.
- Medical treatment and carotid angioplasty is effective for preventing TIA and strokes in such cases.