Atherosclerosis of the carotid arteries

Among numerous vascular diseases, atherosclerosis of the carotid arteries is quite common. This is a chronic pathology, accompanied by a violation of cholesterol metabolism and can lead to life-threatening complications. The development of the disease is slow, progressive, often asymptomatic. The most common complication is ischemic stroke .

Epidemiology

Without affecting the possible causes of the appearance of atherosclerosis of the carotid arteries, in the presence of a tendency to the disease, cholesterol layers are gradually deposited on the internal vascular walls. Clinical signs of damage appear when the arterial vessel narrows by more than 50%: this is when patients begin to turn to doctors.

Atherosclerotic layers most often fill the cervical segment of the carotid artery and have a small extent. The severity of the pathological process is judged by the degree of narrowing of the vascular lumen relative to the normal segment of the vessel located behind the affected area.

Numerous works by scientists have made it possible to prove that with stenosis of the internal carotid artery exceeding 70% of the lumen, the risk of ischemic stroke increases by 5 times. The blood supply to the brain comes mainly from a pair of internal carotid arteries and a pair of vertebral arteries. With arterial stenosis exceeding 70% of the lumen, the basic parameters of blood flow are disturbed, which leads to the formation of microthrombi, damage to the internal vascular wall, instability of atherosclerotic layers and their separation. Moving along the vessel, pathological elements get stuck in it, which leads to ischemia of the corresponding part of the brain and its irreparable damage. [1]

Atherosclerosis of the carotid arteries is one of the pathologies included in the structure of cerebrovascular disease, which in many cases ends in death. Pathology has a prevalence of 6 thousand cases per hundred thousand of the population. The predominant age of patients is over 55 years.

Most often, the disease affects:

• bifurcation zone, where the carotid artery branches into internal and external;
• the mouth of the internal carotid artery (the part closest to the branch);
• the mouth of the vertebral arteries;
• siphon of the internal carotid artery (bend zone at the entrance to the cranium).

Such localization is due to the fact that in these zones there is flow turbulence, which increases the likelihood of damage to the inner wall of the vessels.

Causes of the atherosclerosis of the carotid arteries

Atherosclerosis of the carotid arteries can develop under the influence of many reasons, for example:

• violation of fat metabolism, increased levels of total cholesterol and low-density lipoproteins, lowered levels of high-density lipoproteins;
• systematic increase in blood pressure, hypertension;
• diabetes mellitus, prolonged high blood glucose;
• overweight, hypodynamia;
• smoking, other bad habits;
• malnutrition, excessive consumption of animal fats against the background of a shortage of plant products, abuse of fast food and low-quality semi-finished products;
• regular stress, etc.

It is important to note that all causes of carotid atherosclerosis are still unknown and continue to be studied. As the underlying root cause, scientists call prolonged hyperlipidemia, which leads to the accumulation of cholesterol plaques on the walls of arterial vessels. Additionally, parietal deposition of connective tissue filaments and calcium salts occurs. Plaques gradually increase, change, blocking the blood lumen.

A large role in the initial increase in the content of "bad" cholesterol and triglycerides is played by genetic predisposition, and in general the situation worsens with the advent of chronic diseases that exacerbate disorders of mineral-fat metabolism. [2]These chronic conditions include:

• Hypertension , prolonged use of medications that reduce pressure (antihypertensive drugs adversely affect the course of lipid processes).
• Diabetes mellitus (especially the insulin-dependent type) leads to the early development of atherosclerosis, which is caused by disorders of fat metabolism, an increase in the content of atherogenic lipoproteins in the blood, an increase in collagen production with its further deposition on the vascular walls.
• Pathologies of the thyroid gland, hypothyroidism are accompanied by severe cholesterolemia against the background of a normal level of β-lipoproteins.
• Gouty arthritis is almost always accompanied by hyperlipidemia, a violation of mineral-fat metabolism.
• Infectious and inflammatory processes, such as the herpes simplex virus and cytomegalovirus, often cause underlying lipid metabolism disorders (in about 65% of cases).

Risk factors

Factors that have an indirect effect on the occurrence of atherosclerosis of the carotid arteries can be divided into the following categories:

1. Permanent factors that cannot be eliminated.
2. Transient factors that can be eliminated.
3. Potentially transient factors that can be partially eliminated.

The first category of constant factors includes the following:

• Age, because over the years the risk of atherosclerotic changes increases markedly. Especially often atherosclerosis of the carotid arteries is found in patients older than 45 years.
• Male sex, since men are prone to an earlier start in the development of atherosclerosis. In addition, the disease is much more common in men, which may be due to a large percentage of bad male habits, a greater tendency to eat fatty foods.
• Unfavorable heredity, because atherosclerosis is often "transmitted" through the family line. If parents have been diagnosed with atherosclerosis of the carotid arteries, then children have an increased risk of early development of the disease (before 50 years of age). [3], [4]

The second category of transient factors includes those that each person is able to eliminate on their own by changing their lifestyle:

• Smoking, which is accompanied by an extremely negative effect of tar and nicotine on the vascular walls. In this case, we are talking about both malicious smokers and passive smokers who have been inhaling cigarette smoke for many years and at the same time do not smoke themselves.
• Poor nutrition, associated with the predominant use of animal fats and foods high in cholesterol.
• A sedentary lifestyle that contributes to lipid metabolism disorders, the appearance of other causative pathologies (obesity, diabetes, etc.).

The third category includes factors that can be partially eliminated - for example, to treat existing diseases, establishing control over them to prevent relapse. Provoking diseases can be:

• Hypertension, which entails an increase in the permeability of the vessel wall, the formation of an obstructive plaque, a deterioration in the elasticity of the carotid arteries.
• Lipid metabolism disorder, which is manifested by high levels of cholesterol and triglycerides.
• Diabetes and obesity , accompanied by the same lipid metabolism disorder.
• Toxic and infectious effects that damage the inner walls of blood vessels, which contributes to the deposition of atherosclerotic plaques on them.

It is very important to know the main factors that can contribute to the appearance of atherosclerosis of the carotid arteries. This is necessary, first of all, to understand the basics of preventing the disease, slowing down and facilitating its course. [5], [6]

Pathogenesis

The term "atherosclerosis" consists of the merger of two words:  athero  (porridge) and  sclerosis  (hard). In the process of pathology development, cholesterol, cellular decomposition products, calcium salts and other components are deposited inside the vessels. The disease develops slowly but steadily progresses, which is especially noticeable in patients with high blood cholesterol, high blood pressure, diabetes, etc. The impact of any damaging factor on the vessel wall entails a local inflammatory reaction. Lymphocytes enter the damaged area through the circulatory system, inflammation begins. This is how the body tries to cope with damage. Gradually, a new tissue is formed in this area, the ability of which is to attract cholesterol present in the bloodstream to itself. When cholesterol settles on the vascular wall, it is oxidized. Lymphocytes capture oxidized cholesterol and die, releasing substances that promote a new cycle of inflammation. Alternating pathological processes provoke the formation and increase of atherosclerotic growths, gradually blocking the vascular lumen. [7]

Triglycerides, cholesterol and lipoproteins are involved in the pathogenesis of coronary heart disease, especially atherosclerosis. Reduced concentrations of high-density lipoprotein (HDL) and elevated triglycerides have been shown to be responsible for the genesis of atherosclerotic lesions  [8]. The National Cholesterol Education Program guidelines consider an HDL level below 1 mmol/L to be the threshold below which patients are considered at risk for developing coronary heart disease.[9][10]

The carotid arteries are the most important vessels in the human body. Through these arteries, all brain structures are fed, including the brain, which consumes at least 1/5 of the total volume of oxygen entering the bloodstream. If the lumen of the carotid arteries narrows, then this is inevitable and extremely negatively affects the brain function.

Normally, a healthy vessel has a smooth inner wall, without any damage and additional inclusions. When cholesterol plaques are deposited, they speak of the development of atherosclerosis: the composition of plaques is usually represented by calcium-fat deposits. As the size of the pathological formations increases, the blood flow in the carotid arteries is disturbed.

As a rule, atherosclerotic changes in the carotid arteries are not primary and appear after the defeat of other arterial vessels. The early stages of the disease do not have a stenosing character and do not lead to narrowing of the vascular lumen. However, with the progression of the disease, the situation worsens, the trophism of the brain is disturbed, which in the future may be complicated by ischemic or hemorrhagic stroke.

The work of the carotid arteries must be constant, because the brain always needs oxygen and nutrients. However, under the influence of many causes, atherosclerosis is formed, the blood flow worsens, and brain malnutrition occurs. [11]

Symptoms of the atherosclerosis of the carotid arteries

The presence of atherosclerosis of the carotid arteries is not always possible to suspect, since the pathology often proceeds almost asymptomatically, or the symptoms are diverse and nonspecific. In most patients, the first signs appear only after a significant overlap of the artery - that is, in the later stages of development. Given this, doctors try to pay attention to risk factors in order to suspect atherosclerosis in a timely manner and prescribe appropriate treatment. Obvious signs of the disease can be considered ischemic strokes of various sizes and cerebral manifestations.

• Transient ischemic attacks develop when small particles of atherosclerotic layers break off and block some small cerebral vessel that feeds a certain part of the brain. This site ceases to receive food and dies. Possible symptoms are temporary paralysis of the limbs (lasting from several minutes to several hours), problems with speech and memory, a sharp transient deterioration in vision in one eye, sudden dizziness, fainting. The appearance of such attacks is a serious indication of the risk of stroke in the near future. To prevent complications, the patient should immediately consult a doctor.
• Acute ischemic circulatory disorder of the brain becomes an unfavorable consequence of acute occlusion of the internal carotid artery and entails the death of nerve cells with a partial loss of some brain functions. Every third patient dies, and every second becomes severely disabled.
• Chronic circulatory insufficiency of the brain is provoked by a lack of blood supply to the brain structures, which is caused by arterial stenosis. Brain cells are overstressed, which affects the function of intracellular mechanisms and intercellular connections. Symptoms cannot be called specific: patients complain of a sensation of noise in the head, frequent dizziness, the appearance of “flies” in the eyes, an unsteady gait, etc.

First signs

The intensity and saturation of the clinical picture may be different, but the following signs are considered the most common:

• Pain in the head occurs in the vast majority of patients with atherosclerosis of the carotid arteries. Its appearance indicates a nutritional deficiency of brain structures, which is associated with insufficient blood flow. At first, patients talk about episodic, transient discomfort. Over time, the pain intensifies, the attacks lengthen and become more frequent, starting to disturb several times a day. After taking analgesics, the problem does not disappear completely and for a short time. Characteristics of pain: gouging, drilling, pressing, with predominant localization in the forehead, temples and crown (sometimes - over the entire surface of the head).
• Dizziness can occur on its own or in combination with a headache attack. This sign indicates an increasing trophic disorder in the cerebral structures, as well as problems in the frontotemporal lobes and cerebellum. Additionally, spatial orientation may be disturbed, performance may decrease. In advanced cases, the patient tries to lie more to alleviate the condition. An attack of dizziness can last from 2-3 minutes to several hours. The frequency is individual. As the situation worsens, the symptom worsens.
• Paroxysmal nausea, vomiting, which does not bring relief, are also a sign of a lack of nutrition in the brain. Vomiting is usually single, rarely multiple.
• The state of asthenia, fatigue, and sometimes drowsiness is manifested against the background of a decrease or increase in blood pressure. Weakness, weakness can be present at any time of the day and even in the morning after waking up. The condition is often accompanied by general lethargy, deterioration of external reactions, inattention. To avoid dangerous situations, such patients are not recommended to drive a car, work with various mechanisms, and simply leave the house unaccompanied.
• Sleep disturbances are manifested in the form of frequent awakenings, after which it is difficult for a person to fall asleep. In the morning the patient feels overwhelmed, not rested, and this continues for a long time. Without treatment, there is no question of an independent functional restoration of the nervous system.
• Progressive mental disorders are most often manifested by neurotic syndromes: obsessive-compulsive, hypochondriacal, anxiety disorders. Patients are concerned about deep and prolonged depressive states that are not amenable to psychotherapeutic correction. With organic cerebral damage, the production of serotonin is inhibited, which requires appropriate therapy. However, without direct treatment of atherosclerosis of the carotid arteries, functional recovery cannot be achieved.
• Myasthenia appears if there are violations in the frontal lobe. In patients, muscle rigidity (tension) is detected against the background of a decrease in motor activity. The person has difficulty getting out of bed, walking, etc.
• Intellectual problems, memory impairment in the early stages are found in about 4 cases out of ten. And as the pathological process progresses, mental disorders are already detected in 98% of patients. Symptomatically, there are such disorders as regular forgetfulness, mental retardation, absent-mindedness. A person cannot concentrate for a long time, thinks for a long time, loses the ability to multitask. The development of dementia is unlikely, but even minor cognitive impairments negatively affect the quality of life. Such changes are especially noticeable in people whose professional activities are associated with mental stress. [12].  [13]. [14]
• Numbness of the extremities, paralysis, inability to exercise motor activity, deterioration of tactile sensitivity are rare, only in 1.5% of cases (with the development of pre-stroke conditions).
• Problems with vision and hearing are manifested in the form of loss of visible zones (scotomas), incorrect color perception, loss of the ability to assess distances to an object, bilateral loss of vision (transient blindness). Among auditory disorders, such signs as loss of auditory susceptibility, the appearance of ringing in the ears dominate.
• Neurological disorders are found in the form of unpredictable aggressiveness, tearfulness, hallucinations. Such disorders occur paroxysmal and disappear after a short time.
• Problems with potency in men, violations of the monthly cycle in women, reproductive disorders are usually associated with a decrease in the level of neurotransmitters and hormones in the body, insufficient pituitary and hypothalamic function. Symptoms over the years are greatly aggravated, due to the increasing deficiency of estrogens and androgens.

Initial manifestations of atherosclerosis of the carotid arteries

Clinical symptoms largely depend on the stage of the disease:

• At the initial stage of the development of atherosclerosis of the carotid arteries, the problem may manifest itself only after physical activity or emotional overload, with the disappearance of symptoms at rest. Patients complain of increased fatigue, lethargy, weakness, and difficulty concentrating. In some patients, sleep is disturbed - mainly insomnia appears, which is replaced by daytime sleepiness. Characterized by pain in the head, noise, problems with memory.
• With the growth of the pathological process, hearing and vision can be disturbed, paresis and paralysis, headache and dizziness occur, mood becomes unstable, depressive states may develop.
• In advanced cases, there is a violation of the functions of the limbs, some organs, ischemic processes develop. The ability of orientation in space and time is lost, memory often suffers. These violations become irreversible.

Stages

Currently, experts share the following basic stages of the disease:

1. Formation of lipid elements and bands. The first stage consists in damage to the endothelial layer of the arterial vessel, retention and accumulation of cholesterol particles in the damaged niches. An aggravating factor in this case is high blood pressure. Lipoprotein molecules are taken up by macrophages and transformed into foam cells.
2. Formation of the fibrous element. As foam cells accumulate, growth factors are released, which causes zealous cell division of smooth muscle fibers and the production of elastin and collagen fibers. A stable plaque is formed, covered with a dense fibrous capsule, which has a soft fatty core. Gradually, the plaque increases, narrowing the vascular lumen.
3. Plaque enlargement. As the pathological process progresses, the fat core increases, the fibrous capsule becomes thinner, blood clots form, and the arterial lumen is blocked.

If we talk about the internal carotid artery, then the thrombotic element on its wall can come off, blocking the smaller vessels in diameter. Often such vessels become the middle, anterior cerebral arteries, an ischemic stroke develops.

Forms

According to its origin, atherosclerosis can be different, for example:

• hemodynamic - if it occurs as a result of a prolonged increase in blood pressure;
• metabolic - if it develops as a result of metabolic disorders (disorders of carbohydrate, lipid metabolism, or endocrine diseases);
• mixed - in the case of development as a result of the combined action of the above factors.

In addition, the disease can be stenosing and non-stenosing, depending on the stage of development of the pathology. Non-stenosing atherosclerosis of the carotid arteries practically does not manifest itself in any way: the term means that the overlap of the lumen with cholesterol deposits does not exceed 50%. This pathology can be suspected only by a small systolic murmur in the projection area of the vessels. In some cases, there is a need for conservative treatment.

Stenosing atherosclerosis of the carotid arteries is the next stage in the development of the disease, in which the arterial lumen is blocked by more than 50%. There are signs of cerebral "hunger" with the further gradual development of chronic ischemia or dyscirculatory encephalopathy. The final stage of stenosis is occlusion of the carotid artery.

The criteria for classifying arterial stenosis are defined as: normal (<40%), mild to moderate stenosis (40–70%), and severe stenosis (>70%).

Atherosclerosis is insidious in its initial asymptomaticity: the patient does not suspect anything until the appearance of acute pathological conditions. [15]Cognitive function  [16] largely depends on the degree of carotid stenosis. Patients with severe carotid stenosis always had a lower minimum mental state score compared to the mild to moderate carotid stenosis group (40–70%). [17] Patients with carotid stenosis often experienced minor cognitive problems, but not severe enough to affect daily activities. [18]

According to the localization of the lesion, atherosclerotic lesions of the carotid arteries are of the following types:

• Atherosclerosis of the internal carotid arteries is a lesion of the paired large artery of the neck and head from the bifurcation zone of the common carotid artery: it is there that it is divided into internal and external branches. In turn, the internal carotid artery has several segments: the cervical, stony, segment of the torn foramen, as well as the cavernous, sphenoid, supra-sphenoid and communicative segment.
• Atrosclerosis of the external carotid artery is a lesion of the area from the common carotid artery at the level of the upper border of the thyroid cartilage upwards, behind the digastric and stylohyoid muscles. At the neck of the articular mandibular process, the external carotid artery divides into the superficial temporal and maxillary arteries. In turn, the external carotid artery has anterior, posterior, medial and terminal branches.
• Atherosclerosis of the common carotid artery is a lesion of a paired vessel that begins in the chest, rises vertically and exits into the cervical region. Further, the artery is localized in the area of the anterior part of the transverse processes of the cervical vertebrae, on the side of the esophagus and trachea, behind the sternocleidomastoid muscles and the pretracheal plate of the cervical fascia. The common carotid artery has no branches and only at the upper border of the thyroid cartilage is divided into external and internal carotid arteries.
• Atherosclerosis of the right carotid artery involves damage to the vessel section from the brachiocephalic trunk to the bifurcation zone.
• Atherosclerosis of the left carotid artery begins from the aortic arch along the vessel to the bifurcation zone. The left carotid artery is somewhat longer than the right.
• Atherosclerosis of the carotid and vertebral arteries is a common combination that develops in the elderly. A characteristic feature of such a pathological syndrome is drop attacks - these are sharp falls, not accompanied by loss of consciousness, that occur immediately after a sharp turn of the head. The vertebral arteries are branches of the subclavian arteries that form the vertebrobasilar basin and provide blood supply to the posterior cerebral regions. They begin in the chest and go to the brain in the canal of the transverse processes of the cervical vertebrae. When merged, the vertebral arteries form the main basilar artery.
• Atherosclerosis of the bifurcation of the carotid artery is a lesion of the bifurcation of the common carotid artery, which is localized at the middle of the base of the carotid triangle along the anterior border of the sternocleidomastoid muscles at the upper line of the thyroid cartilage. This location of the pathology is considered the most common.

Complications and consequences

As a result of stenosis of the carotid arteries, the cerebral blood supply gradually worsens, which can lead to the development of a stroke - a violation of blood circulation in the brain. A stroke, in turn, is accompanied by various motor and sensory disorders, up to paralysis, as well as speech disorders.

Often, a plaque or part of it, or a blood clot, comes off from the surface of the inner wall of the carotid artery, which also leads to blockage of smaller vessels and ischemia of a part of the brain. In most cases, a stroke develops acutely, without any initial symptoms. In about 40% of cases, this complication ends in death.

The risk of stroke increases greatly as the pathology progresses and the size of atherosclerotic layers increases. Complications can occur against the background of increased blood pressure, excessive physical or emotional stress.

Prolonged ischemic state of the cerebral cortex, caused by stenosing atherosclerosis of the carotid arteries, entails the development of atrophy of this structure, followed by the appearance of atherosclerotic dementia.

Other adverse effects can be such cerebrovascular pathologies:

• ischemic encephalopathy;
• ischemic cerebral infarction;
• hemorrhagic cerebral infarction;
• intracranial hemorrhages;
• hypertensive cerebral pathologies.

Ischemic encephalopathy is caused by a prolonged state of ischemia due to stenosing atherosclerosis. Typical ischemic damage to nerve cells (damage to the pyramidal cells of the cortex and Purkinje cells of the cerebellum), as a result of which coagulation necrosis and apoptosis develop. The dead cells undergo gliosis.

Diagnostics of the atherosclerosis of the carotid arteries

If a person already has a clinical picture of atherosclerotic changes in the carotid arteries, then it becomes much easier to suspect a pathology. But at the initial stage of development, the disease does not manifest itself in any way, and it can be detected only after studying laboratory blood parameters.

Diagnostic measures at any age begin with an initial examination and anamnesis. During the survey, the doctor finds out the presence of provoking factors, chronic pathologies, and suspicious symptoms. During the examination, he pays attention to the condition of the skin, and listening makes it possible to assess the heartbeat, breathing, etc. In addition to the initial examination, laboratory tests are prescribed - in particular, blood biochemistry, lipid spectrum analysis. Venous blood is taken on an empty stomach: in the blood serum, the level of cholesterol, triglycerides, low-density and high-density lipoproteins is assessed. It is equally important to determine the level of glucose in the blood.

Detailed laboratory studies include the following tests:

• Complete lipid profile:
  • The indicator of total cholesterol is an integral value that demonstrates the quality of the exchange of cholesterol by blood lipoproteins. With an increase in total blood cholesterol above 240 mg / dl, there is a high risk of developing cardiovascular pathologies.
  • Cholesterol / low-density lipoprotein is an indicator that determines coronary risk. Normally, the concentration should be no more than 100 mg / dL.
  • Apolipoprotein B is the basic protein component of atherogenic lipoproteins, the indicator of which reflects their total number.
  • Cholesterol/high density lipoproteins.
  • Apolipoprotein A1 is the basic protein component of high-density lipoproteins.
  • Triglycerides are esters of an organic alcohol of glycerol and fatty acids, an increase in the content of which increases the risk of developing cardiovascular pathologies. The optimal rate is up to 150 mg / dl.
• C-reactive protein is a marker of the acute inflammatory phase. Its concentration reflects the degree of systemic inflammatory response. Atherosclerosis of the carotid arteries is also an inflammatory process that occurs with low intensity.

A micropreparation of venous blood can be used to determine the polymorphism of the endothelial synthase gene, an enzyme that catalyzes the formation of nitric oxide from L-arginine. The deterioration of the enzyme function entails a disorder in the processes of vasodilation and may be involved in the development of atherosclerosis. In addition, the polymorphism of the genes of blood coagulation factors V and II is determined to assess the individual risk of cardiovascular pathologies.

Instrumental diagnostics is most often represented by the following methods:

• Electrocardiography - demonstrates changes in the myocardium and in general in the work of the heart.
• Daily observation of the ECG according to Holter - allows you to track the functional ability of the heart, identify arrhythmia and ischemic changes in the myocardium.
• ECG with stress. [19], [20]
• Bicycle ergometry - helps to assess the function of the cardiovascular and respiratory system in the process of physical activity.
• Echocardiography using ultrasonic vibrations.
• Invasive coronary angiography. [21], [22]
• Coronary CT angiography. [23], [24]
• Nuclear perfusion imaging. [25]
• Magnetic resonance imaging of the heart. [26], [27]

Ultrasound diagnostics is an affordable and easy way to assess the condition of the carotid arteries. It is possible to use procedures such as dopplerography and duplex scanning. In the course of dopplerography, it is possible to examine the speed of blood circulation and determine its violations. Duplex scanning assesses the vascular anatomy, wall thickness and size of atherosclerotic layers. Of course, the second option is more informative. [28]

Recently, three-dimensional (3D) ultrasound has been used to measure plaque volume. Plaque volume can be used as a monitoring tool for the treatment of atherosclerosis. Plaque volume is known to increase without treatment and decrease with statin therapy. [29] 3D ultrasound is thought to be useful for plaque monitoring and may also be useful for evaluating new treatments. [30]

Differential diagnosis

Given the frequent asymptomatic course of carotid atherosclerosis, it is recommended that doctors pay attention to existing risk factors and the presence of a hereditary predisposition: for this, information should be collected from the patient about previous cerebrovascular accidents and transient ischemic attacks, pathologies of other vascular pools, hereditary hyperlipidemia, diabetes mellitus, hypertension, bad habits, etc. Atherosclerosis should also be differentiated from other arterial pathologies:

• bundle ;
• nonspecific aortoarteritis ;
• pathological curvature of the internal carotid artery.

During the external examination, attention should be paid to the neurological status: the presence of hemiparesis, speech disorders. You should also listen to the area of the carotid bifurcation to determine the characteristic systolic murmur.

Asymptomatic patients in whom carotid atherosclerosis is suspected should undergo duplex ultrasound scanning.

Treatment of the atherosclerosis of the carotid arteries

When prescribing treatment for atherosclerosis of the carotid arteries, doctors try to observe the following principles:

• minimizing cholesterol entering the bloodstream and reducing its production by cells by normalizing nutrition with the exclusion of cholesterol-containing foods;
• acceleration of the excretion of cholesterol and its metabolic products from the circulatory system;
• normalization of hormonal levels in women during menopause;
• treatment of infectious and inflammatory processes.

Read more about the treatment of atherosclerosis of the carotid arteries in this article .

Prevention

Atherosclerosis of the carotid arteries cannot be cured completely, you can only stop the development of the disease. Therefore, it is much easier to think in advance and prevent the development of pathology at a young age. This also applies to those people who are at risk - for example, those with genetic disorders or unfavorable heredity. Experts explain: many of us tend to think that atherosclerosis only affects the elderly, but this is not so. The disease begins its development in youth. And the main point of prevention is maintaining a healthy lifestyle. [31], [32]

• Scientists have proven that the amount of cholesterol and triglycerides in the blood that is unfavorable for health largely depends on the presence of physical activity. And an increased content of lipids in the blood is a start to the development of atherosclerosis. With regular physical activity, the function of the cardiovascular system as a whole improves, ischemic processes are prevented. At the same time, there is no need for intense loads: just walking, swimming, playing outdoor games, cycling is enough.
• Proper nutrition is the most important step in prevention. To maintain health, one should “forget” about the existence of such products as fatty meat, lard, lard, offal, heavy cream, margarine and butter. The basis of the diet should be cereals, vegetables and herbs, berries and fruits, low-fat cottage cheese, vegetable oils, fish and seafood, nuts and beans. It is also desirable to significantly reduce the intake of salt, which provokes an increase in blood pressure, as well as sugar and sweets, which can give impetus to the development of diabetes and obesity.
• It is important to maintain a normal body weight, do not overeat, monitor the calorie content of the diet. Excess weight is a risk factor for the development of atherosclerosis of the carotid arteries: in order to prevent the onset of pathology, you need to organize proper nutrition and be physically active.
• Bad habits - in particular, smoking - have an extremely negative effect on the state of the heart and blood vessels: blood pressure rises due to vascular spasms, the walls of blood vessels become fragile, microdamages appear that contribute to "sticking" to the inner walls of atherosclerotic plaques. As for alcohol abuse, it contributes to disruption of the liver and pancreas, which leads to a disorder of fat metabolism. To prevent the development of pathological processes, it is necessary to eradicate bad habits as early as possible.
• Starting from the age of thirty, it is necessary to control the content of cholesterol, triglycerides and glucose in the blood, regularly taking tests. You should also visit your doctor regularly for preventive examinations and diagnostics.

Forecast

The brain is a complex structure capable of controlling various functions of the human body. If there are obstacles to the flow of blood to certain brain areas responsible for certain functions, then the corresponding organs and parts of the body stop working normally. In this situation, the prognosis depends on the degree of damage to the stenotic vessel and the size of the affected area of the brain. The consequences can be different, from temporary transient disorders to the death of the patient. The most common outcomes are motor disturbances, muscle weakness or paralysis, problems with speech, swallowing, urination and defecation, pain and convulsions, and neurological disorders.

Subject to timely therapy, the outcome is considered relatively favorable. If the form of the disease is neglected, then we can talk about relative recovery only in half of the cases. [33]

Atherosclerosis of the carotid arteries with a significant overlap of the vascular lumen can lead to the development of an acute condition, in particular, to a stroke, in which the risk of death is especially high.