Carotid stenosis

Stroke by definition is when a part of the brain is damaged because of a problem with blood flow. Carotid artery disease can lead to strokes, because blood clots can form inside the narrowed artery. Picture: SteemKR

Sound like a carrot smoothie … it is actually the abnormal narrowing of a blood vessel in the neck.

This blood vessel supplies the brain with oxygen and nutrient to function.

To understand this medical condition we have to go back to the basics of the human anatomy (study of the normal human body and its functions) and a little bit about common blood vessel disease in this case artery disease and associated medical conditions like a cerebrovascular accident (CVA) otherwise known as stroke.

The human anatomy should be simple – the blood vessel carries the blood that gets pumped from the heart to the body.

Generally, the artery takes oxygenated blood and nutrient blood away from the heart to the body to be used and vein takes the deoxygenated blood from the body back to the heart.

From the heart, blood gets pumped to the lung to get a fresh supply of oxygen back to the heart and to the body.

The carotid artery supplies the brain with oxygen and nutritions for normal day-to-day function.

According to the American Heart Association (AHA), the normal resting heart for an adult should range from 60 to 100 beats per minute.

A quick calculation to see how fascinating the heart works, eg. the human heart rate while resting, pick a number 60 to 100 beats per minute, say 72 beats per minute.

So the heart beats 4320 per hour and 103,680 beats in 24 hours.

725,760 per week and 2,177,280 per month and 26,127,360 beats per year.

That is a lot of heart beats for one heart, which is the size of your closed fist.

We have only touched the surface of the heart’s many functions.

It’s an amazing organ.

However, we will not digress too far from our topic.

The blood vessel can get clogged for many reasons, for now we will just talk about fatty deposits which cause plaque
formation – this can occur in arteries.

The arteries with these problems can be distinguished according to the organ or location, for example arteries that get affected in the heart are called coronary artery disease (CAD) and in our case arteries in the neck are the carotid artery disease.

There are two main arteries that supply the brain and when plaque form in these arteries.

This result in abnormal, narrowing or stenosis of the artery, as illustrated in the diagram.

Carotid artery stenosis is a narrowing in the large arteries located on each side of the neck that carries blood to the head, face and brain.

The narrowing usually results from atherosclerosis, or a build-up of plaque on the inside of the arteries.

Over time, stenosis can advance to complete blockage of the artery.

Carotid artery diseases can cause cardiovascular accident (CVA) stroke and transient ischemic attack (TIA).

Stroke by definition is when a part of the brain is damaged because of a problem with blood flow.

Carotid artery disease can lead to strokes, because blood clots can form inside the narrowed artery.

Then, the clots and other material from the fatty plaque can travel to the brain and clog smaller arteries.

Some people recover from strokes without lasting effects or with only minor problems.

But many people have serious problems after a stroke.

After a stroke, some people are:

• Unable to speak or understand speech.

• Paralysed on one side of their body.

• Unable to dress, feed, or take care of themselves.

Transient ischemic attacks (TIAs) are basically strokes that last only a short time.

But they do not cause brain damage.

TIAs happen when a blood vessel in the brain gets clogged briefly and then reopens.

People who have TIAs can have the symptoms of a stroke, but the symptoms go away in a short time.

People who have TIAs are at very high risk of having a fullblown stroke.

So the question now is how do I get myself checked to see if I have these conditions?

Yes, the following tests can create pictures which can show abnormalities in arteries.

• Carotid duplex ultrasound – This test uses sound waves to create pictures.

• Magnetic resonance angiography (MRA) – This test uses a magnet to create pictures. It works the same way that MRI tests work. Before having MRA, most people get an injection of a dye that makes the arteries show up more clearly.

• Computed tomography angiography (CTA) – This test uses a special kind of X-ray called a CT scan. Before having the scan, people get an injection of a dye thatmakes the arteries show up more clearly.

For the three tests mentioned, two are done locally.

It is also important to note that when such a test as mentioned above is being done, a specially trained technician
and a certified radiologist must be present to read and make a formal report so that clinical physicians can make decisions for treatment and any intervention if needed.

Prevalence for carotid stenosis

The prevalence of asymptomatic cervical carotid stenosis is low in the general population, but increases with age, which is the most important risk factor.

A study done in 2010 meta-analysis of four population-based studies with individual data from over 23,000 participants, the prevalence estimates for asymptomatic cervical carotid stenosis varies according to age.

The risk increases with age and is higher in male than females.

The first diagram (A) shows individuals with symptoms and the increasing risk with age.

And the second diagram (B) shows asymptomatic (without symptoms) individual and risk with increasing age.

Here is a picture of a Carotid artery in the neck.

This test is a computer tomography angiogram (CTA) where a dye is used in the blood so that a clear outline of the vessel is seen to detect any anomalies.

Here are three pictures, the first one shows abnormal narrowing marked in the circle of the carotid vessel.

The second picture shows the intervention with the specialist catheter-directed to the narrowed area (the two black spot with a guiding wire).

This procedure is called the percutaneous carotid arterial stenting (CAS) and is performed only by trained specialists and this can be done through vascular (blood vessel an artery) access though obtains vascular access through the groin (transfemoral), axillary artery shoulder area – (transaxillary), brachial artery – elbow area (transbrachial),
radial artery wrist (transradial) or direct puncture of the carotid (transcervical).

By far the most common approach is via the right (or left) common femoral artery at the groin area otherwise called
transfemoral CAS [TF-CAS].

These are just technical terms more for identification of the different location access on the body that was used.

And finally, the last image shows the stenosis resolved after the intervention.

What you see here is something we will no longer read about.

This is a treatment available and provided at the Oceania Hospital and these pictures are evident enough this
procedure can be done locally.

This procedure among others is only performed by our trained specialist in a controlled and well-equipped facility with specialised trained personnel.

We continue to evolve in our diagnostic and treatment, and continue to address the leading cause of death in the
world, NCDs.

Keep yourself updated and well-informed on what is happening around you and make the well-informed decision on screening for your health and prevention is always better than cure.

For the last quarter of the year, special promotion packages are given out to the public for screening for men and
women for NCD.

Please check out the website for more information.

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