Stroke can be prevented if you know the basics of its occurrence, risk factors, methods of dealing with the causes. About 80% of ischemic strokes are 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 down, giving branches to the organs along the way. Vessels that feed the upper limbs and the brain depart from the arc. These are brachiocephalic arteries (translated from Latin, shoulder head).
First, there are vessels located on the left side. These include the subclavian artery, which supplies the upper extremity, and the common carotid artery, which rises vertically to the head. They are followed by the brachiocephalic trunk, it is divided into right-sided vessels: common carotid and subclavian.
The subclavian arteries, along their course, give off branches that pass in the transverse processes of the cervicalvertebrae and go to the head. Common sleepy are divided into internal and external. Each of them performs its function. The inner one nourishes the brain, and the outer one nourishes the soft tissues of the head. At the base of the brain, the internal carotid arteries join with the vertebrates to form the circle of Willis. Its role is important in that it redistributes blood flow when a vessel is damaged.
Definition of atherosclerosis
The reason for the decrease in blood supply to the brain, most often, is atherosclerosis of the brachiocephalic arteries. This is a chronic disease in which the vessel wall thickens, and atherosclerotic formations (plaques) form on it. The consequences of this process are a decrease in the lumen, obstruction of blood flow and lack of blood supply.
Atherosclerotically altered brachiocephalic arteries create a high vascular risk of developing cerebral accidents, CCI(chronic cerebrovascular insufficiency), stroke.
In recent years, the incidence of strokes has increased in Russia, 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. About 80% of strokes (ischemic) are 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, withearly menopause or over 55, men over 45).
- If relatives, parents had a history of stroke, heart attack, early onset of coronary artery disease.
- Smoking.
- Hypertension.
- Total cholesterol (TC) more than 5 mmol per liter or low-density lipoprotein (CHLDL) greater than or equal to 3 mmol/L.
- Triglycerides (TG) more than 2 mmol/l, high-density lipoproteins (HDL-C) less than 1 mmol/l.
- Diabetes mellitus, blood glucose over 7 mmol/l on an empty stomach.
- Abdominal obesity is when the waist circumference is wider than 102 cm for men and 88 cm for women.
Diagnosis of atherosclerosis
Total cholesterol should be normal:
- general - 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 HNMK, 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 extended analysis (lipidogram) should be done. This will allow you to know the level of lipoproteins and triglycerides. If the lipid profile does not correspond to the norm, or there are he alth complaints, it is necessary to further study the brachiocephalic vessels.
With atherosclerotic lesions of the brachiocephalic arteries and the occurrence of CNMC, there may be the following clinical manifestations:
- Asymptomatic form, when the vessels are affected, but the patient does not have any complaints,characteristic of reduced brain power. During additional examination, the brachiocephalic arteries have a reduced lumen of varying degrees.
- Transient MC disorders, also called transient ischemic attacks or TIA, when clear neurological symptoms appear (paresis, paralysis, loss of speech, facial asymmetry), but this lasts no more than a day.
- Chronic brain failure (dyscirculatory encephalopathy DEP), which may cause headaches, increased fatigue, dizziness, increased emotionality, sleep disturbance, memory, etc.
- Ischemic stroke. His neurological symptoms depend on which vessel is blocked and how long the blockage lasts.
Duplex scanning of brachiocephalic arteries
The main research method is ultrasound color duplex scanning (USDS).
Most often performed at the initial stage of the examination. It allows you to find out:
- Are the vessels patent.
- Are there any formations inside (atherosclerotic plaques or blood clots), and if so, how much they block the vessel. Plaque growth can be deep into the vessel - stenosing atherosclerosis, or along the vessel - non-stenosing (or slowly stenosing).
- The structure of the vascular wall.
- Is there an anatomical anomaly.
- Blood flow rate.
With stenosis above 50%, duplex scanning of the brachiocephalic arteries, should be done annually for controlbehind the plaque.
Tactics of managing patients with atherosclerosis of brachiocephalic arteries
Symptomatic patients (more than 60% stenosis) are treated with surgery.
For asymptomatic patients (no symptoms) with two or more comorbidities, drug therapy is the best choice. K Surgical treatments include:
- Carotid endarterectomy (CEAE), carotid bypass, internal carotid artery replacement.
- Carotid angioplasty with stenting (CAPS), stenting of the subclavian, vertebral artery.
What kind of operation to perform, and whether it is needed 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 to operate is made strictly according to indications, in accordance with national guidelines for the management of patients with vascular pathology.
If surgical treatment is not indicated for the patient, the doctor gives recommendations for lifestyle changes. All risks must be eliminated:
- monitor blood pressure and blood glucose levels;
- treat comorbidities;
- 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).
Fulfilling all the recommendations of the attending physician, you can avoid surgery.
