Carotid pathology: atherosclerotic disease

It is the involvement of the carotid axis (primitive, internal and external carotid arteries) by arteriosclerotic disease, which is a degenerative disease that can affect any artery in the body. Usually the problem is narrowing of the artery, resulting in a deficit of flow to the brain. Much more rarely there is dilatation of the artery (aneurysm), which can also compromise cerebral circulation or compress neighboring structures in the neck.

Diagnosis of carotid pathology

Carotid pathology is frequently diagnosed in the course of the general examination of patients who present arterial pathology in other arteries of the organism and on other occasions patients are referred by other specialists who treat the consequences of the decrease in cerebral irrigation (neurologists) or in the retina (ophthalmologists). But if there are no symptoms it is difficult to diagnose, since it does not produce pain.

Why does it not produce pain?

The brain lacks pain receptors. In fact, when a stroke occurs, the symptoms may be paralysis or difficulty in speaking, but not pain. That is why it is very important to be able to diagnose this pathology before it produces symptoms that can lead to disability or death of the patient.

What are the consequences?

When the circulatory problem originating in the carotid artery affects the brain, the symptoms are very varied and depend on the cerebral area affected. They may be transient, which we call transient ischemic attack, disappearing after a few minutes, or established. In this case it is a stroke and depending on the affected area and the intensity of the lesion it may improve with time or become permanent. In some cases, unfortunately, it causes the death of the patient. If the affected artery is the ophthalmic artery, it causes total or partial blindness of one eye.

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Treatment to follow

When arteriosclerotic involvement of the carotid artery produces symptoms, the treatment is open or endovascular surgery (each has its own indications). With these techniques, normal flow is restored by eliminating the arterial narrowing that is the cause of the blood supply deficit. If the patient has an aneurysm, it is necessary to operate to remove the dilated arterial part and replace it with the patient’s own vein or a prosthesis and thus restore cerebral blood supply.

It is important to note that carotid surgery is preventive, to avoid damage. If a cerebral or retinal lesion has already occurred, surgery does not allow recovery of the affected area, but it does significantly reduce the risk of subsequent strokes. All patients with carotid pathology should take medication to reduce the risk of thrombosis, should not smoke and should control other cardiovascular risk factors such as hypertension, diabetes, sedentary lifestyle or obesity.