Carotid artery stenting sounds like a great solution for the general public. But the truth is always more complicated. Here, we will explain it here to better understand the illness, diagnosis and treatment options.
Carotid artery
The carotid artery (with the spinal artery) carries blood to the brain. Plaque embolization (or inflamed or artery-blocking plaque spots) is one of the major causes of embolic (or nonhemorrhagic) surgery. In people with this arterial occlusion, treatment or removal of plaque can prevent stroke.
Today we will talk about screening and diagnosis. Next time: treatment options.
Detection of carotid stenosis:
These obstructions can be detected using the carotid Doppler (or ultrasound) to hear the velocity (velocity) of the blood within the carotid artery and visualize the occlusion. Because most different stenoses (or stenoses from plaques) usually do not have fruits, physical examination may be able to hear several obstructions, but this is not necessarily a reliable indicator.
Results are reported as ranges, which determine treatment options. Usually, for people without stroke, surgical treatment is not recommended until blockages are blocked by 70-80%. This is because there is a risk that the stroke will increase with the amount of clogging as the blood velocity increases as it passes through the stenosed space. (Draw a garden hose, stack your thumbs to the end, cover most of it and blow off the water, which means speed has increased).
If a stroke or a light stroke is scattered and migrated to a small blood vessel in the brain, the doctor usually demonstrates that the disorder tends to occur, so the surgeon will undergo surgery with fewer obstructions.
This is important - strokes usually occur due to occlusion (or 100% obstruction) rather than high grade (more than 70 stenoses). This is because there are multiple blood vessels that carry blood to the brain (remember the spine mentioned earlier). Doctors actually increase the risk of stroke at the time of surgery, so do not undo the occlusion.
If you are obstructed, consider that it was fortunate that there was no stroke when it was 99% and worry about keeping the remaining vessels clean with medicines as much as possible.
Screening for carotid artery stenosis:
Currently there are no screening guidelines for asymptomatic individuals. The presence of symptoms means that people stroke, so TIA (mini stroke) to know when to screen is important.
Generally, the screening should be done by those who have an early stage of plaque formation or who have a history of vascular disease (plaque history or other diseases).
High risk of accelerated plaque:
1. Diabetes - Diabetes promotes the formation of plaque. Why the new guidelines, whether blood cholesterol testing should be done with statins (simvastatin, rosuvastatin, lovastatin, atorvastatin, pravastatin)
2. Smoking history - Smoking, like diabetes, shows similar effects in blood vessels. As I explain to patients in the office, by accelerating the blood vessels and hardening the plaque it makes the plaque form faster. This is also important when talking about medical care. Plaque disease
NOTE: Medical management is a term that accurately means managing conditions using drugs (not hardened or fixed). Illness never goes away, but there is an idea that drugs delay the deterioration of conditioning.
A person with a history of vascular disease: Since there is already a history of arterial occlusion, we need to screen these people, but we are not necessarily aware that carotid arteries and other arteries are essentially the same highway not.
Again:
1. A person with a history of coronary artery disease (CAD), such as a previous cardiac stent or a person who has undergone bypass surgery. Indeed, one-third of those who underwent carotid artery screening while waiting for bypass surgery (also called CABG) have serious carotid artery disease or stenosis.
2. Renal artery stenosis (kidney), peripheral arterial disease (PAD), leg obstruction, mesenteric artery disease (abdomen).
3. Abnormal eye examination and those suffering from Amarosis Fugacs - this is basically a small stroke or mini stroke in the eye. Occasionally, people develop symptoms (listed as sudden vision loss like shadows falling on your eyes). At other times, the ophthalmologist sees the plaque in the artery in the eye of examination.
As your doctor (or nurse / doctor's assistant) ordered carotid artery ultrasound, what now?
Ultrasound-carotid duplex
This is an excellent screening tool. You can check if it is blocked. It will not hurt, there are few risks, you can run almost anywhere quite quickly. (Actually, you may be subjected to ultrasonography of the carotid artery at the shopping mall during the health examination.)
If there is a rise in the rate suggesting carotid artery stenosis or stenosis above 70%, it is the decision time. Now some test interpretations are a little complicated - as ranges are used to assess stenosis many studies, 70-79% are in a wide range that means surgical treatment, at least the range you like is at least 60-79% yet 60-69% do not do that.
** Some of my more aggressive patients are seeking less stenosed surgery like 60% or 40% - this is actually not practical for a number of reasons:
1. 60% have a very long time for that level of illness (especially medication)
2. The risk of stroke with this level of stenosis is much less than if one person crosses a 70-80% barrier, so the risk of surgery / stent placement may outweigh the risk of careful waiting . Although the risk of surgery is low (we will talk about it later on - it is not zero), but if the stenosis is terrible it is unequal to take additional risk.
Other diagnostic tests:
At this point, there is a time to make some preliminary decisions. If you absolutely do not want surgery, do not worry about additional examination. We can prescribe medication using ultrasound information.
But - if you are not excluding surgery - CTA or MRA is essential! These tests are more accurate. This is important for a person with a shoulder. Result (60-79% category).
These tests also give the surgeon a road map for work.
1. CTA 0 r Computed tomography by angiography (CT scan)
Many of the surgeons I worked on prefer MRA to MRA for surgical planning. It is inexpensive, imaging is superior in blood vessel structure. Currently, CTA contains a contrast medium. Those who are at risk of kidney disease or kidney complications in amounts greater than the cannula (about 100 ml) of the heart usually receive prevention or MRA.
In previous positions, we developed a CTA protocol to prevent contrast-induced kidney damage using the criteria established by the International Radiology Department's community.
Special procedure order
This helped protect people at high risk of complications. In the end, we should not have caused problems from the inspections used to detect other problems. However, since the examination was all day procedure, I received IV liquids and other medicines.
According to the International Radiation Guidelines, the following patients are at high risk of developing complications.
- Over 75 years old - BUN / elevation of creatinine (kidney disease laboratory) *
Chemotherapy / Radiation-hx - Diabetes
Chronic Kidney - Known Kidney Disease / Last Failure
- organ transplantation hx - some other conditions (see protocol)
* Creatinine usually larger than 1.2
I attached a form for interested readers.
2. MRA - magnetic resonance angiography
This test is based on MRI showing far more detail of soft tissue structure (not necessarily required for vascular surgery, but suitable for other diagnosis). In this test, another toxic dyes are used for people with bad kidney. (However, if there is severe kidney disease or dialysis, this pigment has a risk of complication). For dialysis patients, CTA is generally recommended and tests are conducted the day before the regular dialysis date. )
The results of the study are as follows: 1) stenosis is as serious as previously estimated with ultrasound, and 2) occlusion can reach either surgically or into the laboratory -
It's time to talk about treatment options.
Treatment options include: (and the risk of stroke)
1. Do nothing (always optional) - For a clogged 70-80%, the risk of stroke is about 15% or 1/6. This is a person with a history of stroke or 25% TIAs. I do not have a crystal ball, so anyone who puts 1 in 6 can not tell anyone.
2. Medical care (aka medicine) - medicine is actually effective for many people. Clopidogrel, ASA 81 mg, statin drugs are drugs that are normally prescribed. People with heart history, if not all of them, should already have many people. It has been reported in the literature to reduce the risk of stroke to 8%.
(Of course, this assumes that people are actually taking regular periodic doses, and, surprisingly, most people do not / do not). $ 4 There are statins in the prescription. It is also not a wonderful choice for those with bleeding problems for the history of previous hemorrhagic stroke, hemorrhagic ulcer or falls.
3. Carotid artery Endartarectomy (CEA) - Surgery to clean the artery. This requires a trip to the operating room and often stay overnight. Surgery is quite safe even for very elderly people (although some studies have demonstrated the safety of people in the mid 1990s and 1990s, surgery has a risk of stroke about 1% 39; slightly It is less than 1%, but I rounded it up to the full percent). Basically, the risk of this stroke is centered on the operation time (during surgery and the first 30 days after).
4. Carotid artery stent placement - This option was told to be revisited (by the people who do it) and the stent was told that "the patient refused the operation" for a mild reason. ) In the study, we could not confirm the safety or efficiency of the procedure with stroke rate from 7% to complete 5% in some studies. (Please remember that for many people, 15% must be at home / meaning choosing option 1) Because they misunderstood the patient several years ago, the interventionist Doctors conducting the procedure), or overplaying the (risk) surgical risk and fear and neglect the risk with the stent.
