What are the carotid arteries?

They are two large arteries found on either side of the neck which carry the blood to a great part of the brain, where the speech and memory functions are found, as well as the motor and sensitivity functions, among others. There are two other, smaller arteries, called vertebral arteries, which run down the cervical column and which irrigate the back of the encephalon (brain stem and cerebellum).

What is carotid disease?

As in the case of the coronary arteries, arteriosclerosis may be found in the carotid arteries producing an accumulation of fat and cholesterol (atheromatous plaque) on the wall of the artery. In time this causes a narrowing of the artery and a reduction in the flow of blood to the brain, which can cause what we call a stroke or cerebrovascular accident (CVA). This may happen because the arteries become too narrow, because a part of the plaque comes away and obstructs smaller, distal veins of the brain, or because a blood clot forms at the atheromatous plaque and narrows or obstructs the carotid artery.

A CVA happens when the neurons do not receive the oxygen and glucose carried in the blood. These are essential to the survival of neurons. If the lack of blood lasts longer than 3 ? 6 hours, the damage may be permanent.

How common is the disease?

Cerebrovascular disease is the third cause of death and causes invalidity in thousands of people every year. Having suffered a CVA (stroke), the chances of someone having another within five years is around 25%.

Who is most at risk of suffering stenosis of the carotid artery?

 Those most at risk are:

• Over 50 years old.
• Smokers.
• Diabetic.
• Obese.
• Those with a sedentary lifestyle.
• Those with high blood pressure and/or high cholesterol.
• Those with a family history of vascular disease.
• Anyone who has received radiotherapy to the neck.

What are the symptoms of carotid artery stenosis?

Often, the disease presents no symptoms. It can be fatal or leave the patient invalid, so early diagnosis is fundamental. A transitory ischemic accident (TIA) is a temporary episode of:

• Difficulty in speech or understanding what others say.
• Weakness, pins and needles or paralysis in the face or leg on one side of the body.
• Loss of sight or blurred vision in one or both eyes.
• Loss of balance and coordination.

A TIA may last minutes or a few hours. A TIA is a medical emergency as it is impossible to tell whether it will become a major vascular accident or not. Immediate treatment may save the patient?s life or increase the chances of full recovery.

How is carotid artery stenosis diagnosed?

Apart from the medical examination on which the diagnosis is based, other methods involving image may be used, such as Doppler echography and transcranial Doppler, angioresonance and conventional resonance requiring simple catheterization.

How is carotid artery stenosis treated?

In recent years, endovascular treatment for carotid arteriosclerotic lesions has become a potential therapeutic alternative to surgery by endarterectomy (the surgical removal of the lining of the artery and/or any blockages). Endovascular treatment of carotid lesions using a stent (a small tubular prosthesis inserted in the affected walls of the artery to increase its caliber) has the following advantages over surgical treatment: the greater comfort of the patient, shorter recovery period and lower cost; the absence of a cervical incision, thus eliminating the risk of paralysis of the cranial nerves, bruising and localized infection; other lesions in other arteries can be treated simultaneously (e.g. vertebral or coronary); reduction of morbimortality for high risk patients; and an alternative therapy for patients with non-operable lesions.

How can I find out if I have carotid artery stenosis?

If you believe you may have the disease, you should consult your doctor to arrange for the pertinent evaluation and tests.

Implanting the carotid stent (Prof. Dr Maynar?s technique)

 Most teams carry out the procedure using protection for the brain, that is, they place a device, usually a filter, beyond the lesion so that if any fragments of the atheromatous plaque (an embolus) come away during the angioplasty and the release of the stent, they will be caught by the filter, thus preventing the fragments from obstructing smaller cerebral arteries and causing neurological deficits. 

With Prof. Dr Maynar?s technique we do not use filters as we neither dilate the lesion before nor after the stent is put in place ? that is, we release the stent at the lesion and we allow it to open itself gradually. By not dilating with a balloon angioplasty, we avoid the fragmenting of the plaque and the possible emboli. In addition, the stent traps the atheromatous plaque between the artery wall and the stent itself. This technique avoids the limitations of brain protection devices, simplifies the procedure, cuts costs and reduces the risk of brain damage by reperfusion, which may be caused by the sudden opening of the lesion.

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