What is the Carotid Artery?

The two major arteries located on either side of our neck that carry blood to the brain are called the "carotid arteries" or "şah damarı" (which translates to "main artery" or "royal artery" in Turkish, emphasizing its importance). A significant portion of the blood necessary for nourishing the brain is supplied through these vessels. The most common cause of carotid artery stenosis or occlusion is atherosclerosis (hardening of the arteries).

Atherosclerosis and Risk Factors

Atherosclerosis can affect all arteries in our body, including the carotid arteries, leading to narrowing (stenosis) and blockages (occlusion). The main risk factors for this condition include:

• Obesity (excess weight)
• Family history of heart/vascular disease or stroke
• Sedentary lifestyle
• Smoking or tobacco use
• Diabetes
• Hypertension (high blood pressure)
• High blood cholesterol levels
• Excessive alcohol consumption

Carotid Artery Stenosis and Ischemia

A healthy carotid artery has a flexible structure and a smooth inner surface. However, due to negative factors such as hypertension, high cholesterol, and smoking, the accumulation of fat, calcium, and cholesterol begins in the artery wall. This accumulation leads to atherosclerosis and narrowing of the inner diameter. If blood flow in the carotid artery falls below a critical level, the brain's nourishment is impaired, and this condition is called "ischemia."

If atherosclerosis is left untreated, it can lead to carotid artery occlusion and the development of permanent stroke/paralysis. Carotid artery stenosis is the cause in approximately 30% of patients who experience a stroke.

The Relationship Between Carotid Artery Stenosis and Stroke

Stenosis in the carotid artery can lead to stroke/paralysis in the following three ways:

1. • Complete blockage of the artery as a result of the thickening of the calcified layer on the vessel wall.
   • Obstruction of blood flow to the brain by clots that form on the calcified layer.
   • Blockage of small brain vessels by small fragments that break off from the calcification layer.

   Symptoms

   Stenosis in the carotid artery usually does not cause symptoms. However, when the narrowing reaches a critical level, the blood flow needed by the brain decreases, and transient ischemic attack (TIA) symptoms may occur. These symptoms usually last less than 24 hours:

   • Numbness or tingling
   • Loss of strength
   • Facial paralysis, drooping lip
   • Blurred vision or vision loss
   • Difficulty speaking
   • Loss of balance
   • Loss of consciousness

   Transient ischemic attacks are warning signs for the risk of permanent stroke.

   Diagnostic Methods

   The following tests can be performed to diagnose stenosis in the carotid artery:

• • Doppler ultrasonography
  • MR angiography (MRA)
  • CT angiography (CTA)
  • Catheter angiography (Digital Subtraction Angiography - DSA)

  Doppler ultrasonography is the primary test used for the initial detection of stenosis in the carotid artery. Following this examination, advanced imaging methods may be needed for treatment planning.

  Treatment Methods

  The approaches to treating stenosis in the carotid artery are:

1. Medication Therapy

   In cases where the stenosis does not reach 50%, controlling risk factors and medication therapy may be sufficient. These measures include:

   • Healthy lifestyle (active living, balanced diet)
   • Smoking cessation
   • Control of blood pressure, blood sugar, and cholesterol levels
   • Antiplatelet drugs (e.g., aspirin)
   • Limiting alcohol consumption

   Interventional Treatment

   When stenosis reaches 70%, medication therapy may not be sufficient. In this case, interventional treatments such as open surgery (endarterectomy) or carotid stenting are considered:

   • Endarterectomy: The carotid artery is surgically opened, and the calcium and fatty deposits inside the vessel are cleaned out.
   • Carotid Stenting: A stent is placed inside the artery through a minimally invasive method from within the vessel. During this procedure, a clot protection device is used to prevent clots from traveling to the brain vessels.

Stent Treatment

Stent treatment is performed by inserting a small catheter into an artery in the patient's groin area. During the procedure:

1. A clot protection device is deployed.
2. A stent is placed in the area of stenosis.
3. If necessary, the artery is widened with balloon angioplasty.

After the procedure, the patient is usually monitored in the hospital for 1-2 days and can return to their daily life if no complications develop.

Risks and Follow-up

The risk of stent treatment is less than 1%. The most serious complication is the escape of a clot into the brain vessels. After the procedure, it is recommended that the patient be followed up with Doppler ultrasonography after 3 months and CT angiography after 6 months.

After treatment, controlling the factors that cause vascular calcification will prevent the recurrence of the disease or the formation of new stenoses. Therefore, the patient's blood pressure, blood sugar, and cholesterol levels should be monitored regularly, and appropriate medication treatments should be administered if necessary.

This information has been verified with medical information confirmed by specialist physician İbadat Hasanov and aims to inform individuals. In any case, the treatment plan is determined specifically for you, and this decision is meticulously evaluated by your doctors.