Dr Paulino Souza Neto Vascular Surgery, Endovascular Surgery

English » Arterial Diseases » Carotid Stenosis

The stenosis (narrowing) of the carotid artery constitutes the 3rd cause of Cerebrovascular Accidents (strokes) in the world, causing 50 mi deaths per year globally. Screening for this condition shall be performed routinely since the preventive treatment of this condition is a factor os social economic inclusion since the sequelae and financial costs are devastating. Extense Cerebrovascular Accidents lead to a 33% mortality rate in the 1st year and the survivors live in average more 6 years with the yearly cost of US$151,000.00 per patient in Home care and support to the sequels of the event. Its major cause is Atherosclerosis. The ischemic stroke is caused by a temporary or permanent blockage of the arterial vessels nurturing the brain and its manifestation is directly dependent of the area deprived of circulation. Hence the sudden lost of vision is the manifestation of an acute retina artery occlusion and a deficit in sensibility or strength in the half of a body express the occlusion of the middle cerebral artery.

The carotid artery stenosis condition is widely discussed and evaluated in multi center studies and has a well defined working flow. Those studies reveal that strokes were less prevalent among patients with stenosis lesser than 60% under clinical treatment and among patients with stenosis equal or superior to 70% stenosis submitted to surgical treatment (Angioplasty or Endarterectomy). The individuals with stenosis between 60 and 70% is the group that has to be evaluated case by case.

The screening of carotid artery stenosis is performed by the color Doppler Ultrassound of the Carotid and Vertebral arteries with a 91% sensibility and 87% specificity.

If a stenosis is detected, an additional study with a non invasive study (AngioMR or AngioCT) shall be performed. In some cases a diagnostic Angiography might be needed.

With this data in hands we may define the best approach to each patient. 

The indication between Angioplasty and open surgery (Endarterectomy) relies on the evaluation of multiple factors like age, associated diseases, simultaneous stenosis, ongoing stoke among other factors. 
Currently there is a preference to the Angioplasty technique due to its lower risks and fast recovery but the surgery still remains the first option among young patients with unilateral stenosis and few associated diseases.

On the other hand the endovascular approach is well accepted among high surgical risk patients, multiple associated diseases, hostile neck (previous surgery, radiotherapy scars or high bifurcation of the carotid artery) as well as bilateral carotid stenosis.

The best centers present an incidence of ischemic complications of less than 0,2%. The recovery from such complications is also a good marker of quality of assistance of the center.

Medical treatment

The medical treatment is fundamental even for the ones submitted to an intervention. Hence the control of the risk factors is of capital importance. Control of the Chronic Diseases (Hypertension, Diabetes, Dyslipidemia) avoid unhealthy habits (Sedentary lifestyle, smoking) and medical treatment with anti-platelet drugs, statins) are of major importance in the adjuvant therapy of this condition.

The best medical choice for each patient depends on a critical evaluation by the physician.

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