A stroke can be prevented if you know the basics of its occurrence, risk factors, methods of dealing with causes. About 80% of ischemic strokes occur due to damage to the carotid or vertebral arteries.
Brief anatomy
The largest vessel in the body is the aorta. It originates from the left ventricle of the heart, then forms an arc and descends vertically downward, giving along the branches to the organs. From the arc depart the vessels that feed the upper limbs and the brain. These are brachiocephalic arteries (translated from Latin, the head shoulder).
First there are vessels located on the left side. These include the subclavian artery, which supplies the upper limb and the common carotid, which rises vertically up to the head. They are followed by the brachiocephalic trunk, it is divided into right-sided vessels: the common carotid and subclavian.
The subclavian arteries, in their turn, give away branches that extend in the transverse processes of the cervical vertebrae and are sent to the head. Common sleepy are divided into internal and external. Each of them performs its function. The inner nourishes the brain, and the outer soft tissue of the head. At the base of the brain, the internal carotid arteries connect with the vertebrates, forming the Willis circle. Its role is important in that it redistributes the flow of blood when the vessel is affected.
Definition of Atherosclerosis
The cause of the decrease in blood supply to the brain, most often, is atherosclerosis of the brachiocephalic arteries. This is a chronic disease in which there is a compaction of the vessel wall, the formation of atherosclerotic formations (plaques) on it. The consequences of this process are a decrease in clearance, obstruction of blood flow and a lack of blood supply.
Atherosclerotically altered brachiocephalic arteries create a high vascular risk of developing brain disasters, chronic heart failure (chronic cerebrovascular insufficiency), and stroke.
In recent years, the incidence of strokes in Russia has increased, and this is more than 400 thousand cases per year. About 70-85% of them are ischemic, that is, associated with a decrease in blood supply due to narrowing of the mouth of the vessel or its blockage. Somewhere 80% of strokes (ischemic) occur due to atherosclerosis of the vertebral or carotid arteries.
Risk factors
There are many risk factors that can lead to the development of pathology. These include:
- Age (women, with early menopause or over 55 years old, men over 45 years old).
- If the relatives, parents had a history of stroke, heart attack, early onset of coronary heart disease.
- Smoking.
- Hypertonic disease.
- Total cholesterol (OXS) more than 5 mmol per liter or low density lipoproteins (HLDPL) greater than or equal to 3 mmol / L.
- Triglycerides (TG) more than 2 mmol / L, high density lipoproteins (HLPVP) less than 1 mmol / L.
- Diabetes mellitus, blood glucose more than 7 mmol / l on an empty stomach.
- Abdominal obesity is when the waist is wider than 102 cm in men and 88 cm in women.
Diagnosis of Atherosclerosis
Total cholesterol should be normal:
- total - less than 5 mmol / liter;
- LDL cholesterol - below 3 mmol / l;
- HDL cholesterol - greater than or equal to 1 mmol / l;
- TG - less than 1.7 mmol / L.
Even if there are no symptoms of CNMC, but there are two or more risk factors, it is necessary to undergo an examination in order to exclude atherosclerosis. The annual clinical examination includes a study of total cholesterol, with an increase in its level above 5 mmol / l, an advanced analysis (lipid profile) needs to be done. This will allow you to know the level of lipoproteins and triglycerides. If the lipid profile is not normal, or there are complaints about the state of health, it is necessary to further conduct a study of brachiocephalic vessels.
With atherosclerotic lesions of the brachiocephalic arteries and the occurrence of chronic heart disease, there may be the following clinical manifestations:
- An asymptomatic form, when the vessels are affected, but the patient does not have any complaints characteristic of a decrease in brain nutrition. Upon further examination, the brachiocephalic arteries have a reduced lumen of varying degrees.
- Transient MK disorders are also called transient ischemic attacks or TIAs when clear neurological symptoms appear (paresis, paralysis, speech loss, facial asymmetry), but it lasts no more than a day.
- Chronic cerebral insufficiency (DEC discirculatory encephalopathy), in which there may be headaches, increased fatigue, dizziness, increased emotionality, sleep disorder, memory, etc.
- Ischemic stroke. Its neurological symptoms depend on the vessel in which the blockage occurred and how long this condition lasts.
Duplex scanning of brachiocephalic arteries
The main research method is ultrasonic color duplex scanning (SPL).
Most often performed at the initial stage of the examination. It allows you to find out:
- Are the vessels passable?
- Are there any formations inside (atherosclerotic plaques or blood clots), and if so, how much do they overlap the vessel. Plaque growth may be deeper into the vessel — stenotic atherosclerosis, or along the vessel — non-stenotic (or slowly stenotic).
- The structure of the vascular wall.
- Is there an anatomical anomaly?
- Blood flow rate.
With stenosis above 50%, a duplex scan of the brachiocephalic arteries must be taken annually to control the plaque.
Management tactics for patients with atherosclerosis of the brachiocephalic arteries
Symptomatic patients (with stenosis of more than 60%) are indicated for surgical treatment.
For asymptomatic patients (without symptoms) who have two or more concomitant diseases, drug therapy is the best choice.
Surgical treatment methods include:
- Carotid endarterectomy (CEAE), carotid- connected shunting, prosthetics of the internal carotid artery.
- Carotid angioplasty with stenting (CAPS), stenting of the subclavian, vertebral artery.
What kind of operation is performed, and whether it is necessary at all, is decided by cardiologists and cardiac surgeons, depending on age, degree of vascular stenosis, concomitant pathology, and other features. That is, after assessing all the risks. The decision on the operation is made strictly according to indications, in accordance with the national recommendations for the management of patients with vascular pathology.
In the event that surgical treatment is not indicated to the patient, the doctor gives recommendations on lifestyle changes. All risks must be excluded:
- monitor blood pressure and blood glucose;
- treat concomitant diseases;
- quit smoking and give up alcohol;
- follow a diet that restricts animal fats and carbohydrates;
- pay attention to physical activity, daily walking, morning exercises;
- take statins (drugs of this group will be selected by a therapist or cardiologist).
By following all the recommendations of the attending physician, surgical intervention can be avoided.