Stenosing atherosclerosis of the brachiocephalic arteries
Atherosclerotic changes in the brachiocephalic arteries (BCA) are lipid deposits within the walls of the vertebral and carotid arteries in the cervical spine. As a result, the artery narrows, impairing its patency. Stenosis or narrowing of the arteries supplying the brain leads to insufficient blood supply to this organ and stroke.
At the K+31 Clinic, we perform carotid endarterectomy surgery. Surgeons restore blood flow to the affected vessels, preventing severe brain dysfunction.
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Causes and Symptoms of Atherosclerosis of the BCA
The main cause is microscopic damage to the vascular walls due to fluctuations in blood pressure. Other predisposing factors include:
- Bad habits – smoking, drinking alcohol
- Poor diet, consumption of large amounts of fatty meats – pork, lamb
- Obesity
- High blood sugar, diabetes
- Hereditary predisposition
Today, atherosclerosis is not only a disease of elderly patients; vascular plaques are also diagnosed in young people.
In the early stages, the disease has no specific symptoms. As the disease progresses, the patient may experience tinnitus, memory loss, and decreased concentration. When the vitreous body is damaged, characteristic "flashes" appear before the eyes.
Stroke is a dangerous consequence of atherosclerosis. It is characterized by symptoms such as:
- Speech impairment – the person has difficulty pronouncing words, constructing sentences, and speech becomes slurred.
- Numbness of the facial muscles, impaired facial expressions – a crooked smile, drooping eyelids.
- Problems with coordination, impaired gait.
- A feeling of "fog" in the head, fainting.
If these symptoms appear, the patient requires immediate medical attention.
Indications for surgery
Currently, there are no medications that can reduce or completely dissolve atherosclerotic plaques. Conservative treatment may include aspirin and statins. These slow the growth of lipid deposits and reduce the risk of thrombosis. It is important to correct associated factors such as high blood pressure and diabetes, monitor your weight, and maintain an active lifestyle.
The primary method for eliminating stenosis or narrowing of the arteries is surgery. Here are the indications for surgery:
- Severe atherosclerosis
- The vessel lumen is narrowed by 2/3 or more
- The patient was diagnosed with unstable blood clots that could break off
- Regular severe headaches
- History of stroke
- Cognitive impairment
- Necrosis in other organs due to narrowing of the arteries and impaired blood flow
- Dementia developing due to organic brain damage
Surgery is prescribed when cholesterol plaques form on the inner part of the carotid artery. Before surgery, doctors evaluate the feasibility of the procedure and the risks.
Contraindications
Surgical plaque removal is not performed on people with severe cardiac, vascular, or respiratory conditions. Contraindications include damage to the second carotid artery and decompensated diabetes.
If the plaque is located in a hard-to-reach area, removal may be difficult.
Methods for diagnosing atherosclerosis of the coronary arteries
If arterial dysfunction is suspected, the patient is consulted by a neurologist. The specialist reviews the patient's medical history and symptoms and orders an ultrasound examination of the neck vessels. This method allows for the identification of stenotic lesions, their location, and impaired blood flow.
To confirm the diagnosis, the patient undergoes a CT scan with a contrast agent or an MRI. These examinations reveal the size of the narrowing, the plaque structure, and the anatomical features of the vessels, such as bends and loops.
Another diagnostic method is cerebral angiography or X-ray imaging of the vessels. To visualize the vessels, the doctor injects the patient with a contrast agent containing iodine. The X-ray image shows the vascular pattern, including bends, narrowing, and abnormal areas.
A week before the surgery, the patient undergoes preparation: a complete blood count, urine analysis, and an ECG. If a patient has cardiovascular disease, a cardiac ultrasound will be required.
Treatment methods
The non-stenotic form can be treated conservatively. The doctor prescribes cholesterol-lowering medications, anticoagulants, and blood thinners. Lifestyle modifications are essential: a diet low in animal fats, quitting unhealthy habits, and incorporating daily physical activity.
If the lumen becomes stenotic, a decision is made regarding surgical intervention. The procedure is performed in two ways.
Carotid endarterectomy
The surgery is performed on an empty stomach; fasting should be stopped 12 hours before the procedure. The anesthesiologist administers local or general anesthesia. The surgeon prepares the area with an antiseptic and dissects the soft tissue.
The damaged vessel is separated from healthy tissue. The surgery is performed in two ways: classical or eversion. In the former, a longitudinal incision is made on the affected vessel at the site of the plaque. The surgeon then removes the affected area: the damaged area, along with atherosclerotic masses and thrombi, is exfoliated, and the vessel and soft tissue are sutured.
With the eversion technique, the specialist makes a transverse incision, and the vascular section is turned inside out. The plaque is removed, and the vessel ends are sutured.
Endovascular stenting
Our surgical department performs stenting—a minimally invasive procedure that requires no large incisions; local anesthesia is sufficient. The surgeon cleans the area with an antiseptic and administers anesthesia; the patient remains conscious but pain-free.
The surgeon performs a puncture—a small incision—in the brachial artery. A catheter is inserted into the vessel lumen. Under X-ray guidance, the thin tube is passed to the pathologically stenotic area.
A contrast agent is injected through the catheter; the patient may feel a flush in the face. The contrast agent allows the affected area to be visualized.
A filter is placed inside the vessel to collect plaque fragments, which can be removed during the procedure. On the other end of the catheter is a balloon that inflates the vessel, making it wider.
Using a second catheter, the surgeon places a stent—a small metal mesh tube—into the artery. When opened, it supports the vessel wall. The stent's position is then adjusted.
At the final stage, an angiogram is performed—an X-ray with the injection of a contrast agent. This allows for an assessment of the artery's condition after surgery. A sterile dressing is applied to the surgical site.
Stenting takes 1–2 hours and requires no lengthy recovery time due to the absence of large incisions.
General information
How the surgery is performed
The exact procedure depends on the chosen technique. Here are the stages of open endarterectomy:
- Choosing a safe anesthetic—general or local
- Separating the artery from other structures—healthy vessels, nerve fibers
- Installing a temporary bypass—this helps prevent complications in the brain when the carotid artery is compressed.
- Dissection of the artery and removal of atherosclerotic masses
- Replacing the artery to its original position
- Restoring vessel integrity, suturing
- Restoring blood supply, checking the quality of the sutures. A cosmetic suture is placed on the damaged skin.
Vital signs must be monitored during surgery. If the patient is conscious, specialists maintain verbal contact with them.
Possible complications
Stent placement and vascular plaque removal can lead to complications such as:
- Occlusion of blood vessels in the brain - a condition that can lead to stroke and requires emergency medical care.
- Recurrence of blood clots, recurrent stenosis
- Bleeding at the site of catheter placement, formation of large hematomas
- Formation of a communicating segment between the vein and the operated artery
The risk of complications increases with extensive stenosis, large thrombotic masses, and severe vessel curvature. Which complicates stent insertion. At-risk groups include patients over 80 years of age and those with hypertension.
If the following symptoms occur after surgery, consult a doctor as soon as possible:
- Severe swelling in the artery area, pain
- Wound discharge, bleeding
- Redness of the skin, fever
- Chest pain
According to statistics, postoperative high blood pressure occurs in 20% of people - this condition is easily treated in the hospital and resolves within a few hours.
Hyperperfusion develops in 1–3% of patients. This symptom is characterized by severe headaches, seizures, and neurological manifestations. In this condition, it is important to urgently lower blood pressure to at least 140 mmHg. Art.
Important: If surgical technique is followed and the surgeon's recommendations are followed during recovery, the risk of complications is minimal. Our clinic's patients tolerate the procedure well and quickly return to daily life.
Without treatment, atherosclerosis of the brachiocephalic arteries can lead to serious consequences, including death. Common complications include:
- Memory impairment, absent-mindedness, and overall cognitive impairment.
- Vision impairment, sometimes complete loss of vision.
- Cerebral infarction.
- Thrombosis, blockage of vital arteries by a detached clot.
Since many complications can be life-threatening, it is important to undergo prompt diagnostic testing, after which the doctor will select the optimal surgical technique.
FAQ
What tests are required before cholesterol plaque removal surgery?
The exact list of tests is prescribed by the doctor. In most cases, a complete blood count and urine analysis, a biochemical analysis, testing for infectious diseases (HIV, hepatitis), and a coagulation profile to assess blood clotting are required.
What tests are required before cholesterol plaque removal surgery?The exact list of tests is prescribed by the doctor. In most cases, a complete blood count and urine analysis, a biochemical analysis, testing for infectious diseases (HIV, hepatitis), and a coagulation profile to assess blood clotting are required.
What tests should be performed after carotid endarterectomy?
The doctor schedules ultrasound examinations of the arteries. Ultrasound allows for the absence of recurrence and, if narrowing recurs, prompt action.
Can I exercise after stenting?
After stent placement, there will be a small puncture in the skin that heals quickly. Light physical activity, such as walking, is permitted the day after surgery. After two weeks, you can return to strength training, cardio, dancing, and swimming. Intense physical activity is permitted only with a doctor's approval: complications may occur with underlying cardiac or vascular conditions.
Should I feel any pain after the surgery?
The procedure is performed under general or local anesthesia; the patient feels no pain or discomfort. After the procedure, slight pressure on the surgical site may be felt. If you experience severe pain, bleeding, or a deterioration in your general health, consult a doctor as soon as possible.
What lifestyle should I maintain after surgery?
To prevent recurrence and re-accumulation of fatty deposits, try to maintain a healthy, active lifestyle. Follow a diet free of fried foods, large amounts of red meat, and animal fats. Your diet should include sufficient fiber, vegetables, and plant-based fats. Quit smoking, a major factor in the development of atherosclerosis. Gradually incorporate physical activity into your lifestyle.
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