Atherosclerosis of the cervical vessels

Atherosclerosis of the cervical vessels, as well as other arteries, refers to diseases of the circulatory system, caused by the accumulation of cholesterol in them in the form of plaques, which are formed in places of micro-damage to the vascular walls.

Epidemiology

According to the latest data of The Lancet Global Health, the global prevalence of atherosclerotic plaques in the walls of carotid arteries with their thickening is estimated at 21-27.6% in the age category 30-80 years. And the incidence of carotid artery stenosis is 1.1-2.1% of the population and increases with age, especially in men.

According to studies, this pathology of the circulatory system is most affected by the population of the Western Pacific region (33.4%), and the least (6.1-6.2%) carotid atherosclerosis affects the inhabitants of Africa and the Eastern Mediterranean countries.

It should be borne in mind that 10-20% of strokes are the result of atherosclerotic lesions of the carotid arteries.

Causes of the atherosclerosis of the cervical vessels.

The causes of atherosclerosis, which is a systemic pathology, lie in a disorder of fat metabolism, which leads to hypercholesterolemia [1] - excessive blood levels of cholesterol (a waxy fat-like substance) and low-density lipoproteins (LDL), which carry cholesterol into the artery walls. [2]

All the details are in the publications:

• Atherosclerosis - Causes and risk factors
• Causes of high and low total cholesterol
• Causes of low-density lipoprotein elevations and decreases

Which vessels in the neck can be affected by atherosclerosis? First of all, these are the paired common carotid arteries (arteria carotis communis), which rise up the neck lateral to the trachea and esophagus. As a rule, the lesion of the posterior wall of this vessel is most pronounced just below the bifurcation to the internal and external carotid arteries. Plaques can also be deposited in the walls of the cervical part of the internal carotid arteries - at the branching point from the common carotid artery.

There is atherosclerosis of the paired vertebral or vertebral arteries of the neck (extracranial vertebral arteries), which branch from the subclavian arteries and - passing through openings in the transverse processes of the cervical vertebrae (at the level of C6-C7) - follow up the posterior surface of the neck. After their entrance into the skull through the large occipital opening, they form the basilar artery of the base of the brain, which continues to supply blood to the brain. Atherosclerotic lesions of the proximal part of the vertebral artery (its initial segment) are particularly common. [3]

Pathogenesis

The pathogenesis of atherosclerosis of any localization is due to the formation of plaques consisting of cholesterol, calcium and fibrous tissue in the vessel wall - its inner lining (tunica intima).

The mechanism of their formation is discussed in detail in the article - Atherosclerotic plaques

Plaque formation is accompanied by fibrosis, thickening of the vascular wall and loss of its elasticity. And plaque protrusion into the vessel lumen leads to its narrowing - stenosis or complete occlusion - occlusion.

Symptoms of the atherosclerosis of the cervical vessels.

In carotid artery atherosclerosis, symptoms manifest as weakness, dizziness and sudden severe headaches, tinnitus, facial numbness, temporary hearing and vision impairment, and episodic loss of consciousness.

Atherosclerotic lesions of the vertebral arteries of the neck cause transient hypoperfusion of the posterior structures of the brain, which is manifested by symptoms of vertebrobasilar insufficiency: the same attacks of vertigo, tinnitus, as well as impaired coordination of movements and balance (ataxia), nystagmus with problems holding the gaze, diplopia (double vision), impaired fine motor skills. There may also be headaches, nausea, vomiting, speech difficulties, and mental changes.

Complications and consequences

In cases of atherosclerosis of the blood vessels of the neck (carotid arteries and vertebral arteries of the neck), serious consequences and complications such as:

• narrowing or stenosis of the carotid artery with decreased cerebral blood flow;
• ischemic attack in the form of transient ischemic attack - due to temporary disruption of blood flow to the brain;
• ischemic stroke;
• cerebral embolism.

Atherosclerosis of extracranial vertebral arteries (especially at the point of vessel branching from the subclavian artery) is complicated by their stenosis and is considered the cause of almost 25% of cases of ischemic stroke of the posterior circulation (vertebrobasilar basin).

Diagnostics of the atherosclerosis of the cervical vessels.

Many people don't know they have cervical vascular atherosclerosis until they need emergency medical attention.

As with atherosclerosis of other vessels, diagnosis includes medical examination, medical history, laboratory tests, diagnostic imaging. Blood tests are required: general, biochemical, for the level of total cholesterol, LDL, HDL, triglycerides, for clotting factors.

Only instrumental diagnostics can detect and visualize atherosclerotic lesions of the carotid arteries or vertebral arteries of the neck: duplex scanning of the vessels of the head and neck, CT or MR angiography with contrast enhancement. [4]

Differential diagnosis

A differential diagnosis is made with the exclusion of: cerebral circulation disorders with chronic arterial hypertension or atherosclerosis of cerebral arteries; vertebrobasilar syndrome (caused by osteochondrosis or osteoarthritis of cervical vertebrae, intervertebral hernia or spondylosis); nonspecific aortoarteritis of carotid and vertebral arteries; amyloid angiopathy; lesions (altering syndromes) of the brainstem and medulla oblongata.

Treatment of the atherosclerosis of the cervical vessels.

Treatment of cervical vascular atherosclerosis is aimed at preventing stroke. Specific methods depend on the degree of vascular stenosis. If the narrowing of the lumen of the carotid artery does not exceed 50%, medications are prescribed to reduce cholesterol and control blood pressure. Read more:

• Atherosclerosis - Treatment
• Treatment of high cholesterol
• Pills for high cholesterol

And to slow the progression of the pathological process (that is, to bring the cholesterol level to normal - 5.0 mmol / l) require lifestyle changes. In particular, regular exercise is recommended, as well as diet for atherosclerosis of the cervical vessels of the brain. [5] More information in the materials:

• Diet for high cholesterol
• Diet for atherosclerosis

In cases of significant carotid artery stenosis and a history of ischemic attacks, surgical treatment may be performed:

• removal of the plaque blocking the artery - endarterectomy;
• balloon angioplasty and/or arterial stenting.

Prevention

To prevent or slow the progression of atherosclerotic lesions of the cervical vessels, doctors recommend: quit smoking, minimize alcohol consumption, maintain a normal weight, move more, and eat right. Read more:

• Proper nutrition
• How do you prevent ischemic stroke?

Forecast

With atherosclerosis of the carotid or extracranial vertebral arteries, the prognosis depends on the development of its consequences - stenosis of the vessel and stroke (with motor, sensory, speech and visual impairments), which can be fatal.

The fact that 64% of stroke patients over the age of 60 have cognitive impairment does not add to the optimism.