Stenosing atherosclerosis

When due to atherosclerotic lesions of arterial vessels there is a narrowing of their lumen with reduced blood flow, stenotic atherosclerosis (from Greek stenos - narrow) is diagnosed. [1]

Epidemiology

Although the exact statistics of stenosing atherosclerosis is not available, according to some foreign studies, the prevalence of carotid artery stenosis is estimated at 1.5% of the general population (almost 58 million cases per year); coronary atherosclerotic stenosis accounts for more than 12% of cases, and the frequency of detection of this pathology of the renal artery (often with simultaneous atherosclerotic lesions of other arterial vessels) is 15%.

A higher prevalence of atherosclerosis, including stenosing atherosclerosis, is observed in elderly men (almost twice as often as in women). [2]

Causes of the stenosing atherosclerosis

Unlike subclinical (asymptomatic) atherosclerosis, stenosing atherosclerosis is a later - symptomatic phase or stage of atherosclerotic lesions of arteries of various localizations. And its main causes lie in disorders of lipid metabolism, i.e. fat metabolism, which lead to hypercholesterolemia and hypertriglyceridemia, defined in medicine as dyslipidemia.

More in the publication - Atherosclerosis - Causes and Risk Factors

Arterial stenosis, accounting for 50-60% of its lumen, significantly affects their "carrying capacity" and can cause hemodynamically significant reduction in blood flow.

Among the risk factors for atherosclerosis, experts note metabolic syndrome, arterial hypertension, hyperhomocysteinemia, insulin resistance and diabetes mellitus, thyroid hormone deficiency, chronic renal failure, obesity, smoking, age after 50, and genetic predisposition. [3]

Pathogenesis

The main role in the pathogenesis of atherosclerosis is played by atheromatous or atherosclerotic plaques formed in the vessel wall - between its inner sheath (intima) and middle sheath (media). These are compact accumulations of low-density lipoprotein cholesterol (LDL-C), foam cells (macrophages that have engulfed LDL), monocytes (T lymphocytes), fibroblasts, and smooth muscle cells. Then there is fibrous thickening and thickening of the intima of the affected area, as well as calcification of the plaque. [4]

Atherosclerotic lesion of the vascular wall progresses, and as the plaque enlarges, it bulges into the vessel lumen, which mechanically narrows the artery. At the same time, the function of endothelial cells (lining the vessels and ensuring the stability of intravascular homeostasis and hemodynamics) is disturbed: they express special membrane proteins and glycoproteins (intercellular adhesion molecules and selectins), which facilitate the binding of X-LDL to the endothelium, and also increase the production of proinflammatory factors (prostaglandins), vasoconstrictor enzymes and blood clotting factors.

In addition, at plaque rupture under conditions of turbulent blood flow there is hemorrhage with thrombus formation, which is formed under the influence of plaque lipid core contents and components of extracellular matrix of damaged endothelium on circulating platelets in blood. [5]

Symptoms of the stenosing atherosclerosis

In stenosing atherosclerosis, symptoms depend on its localization and the degree of narrowing of the corresponding artery.

For example, stenotic atherosclerosis of the coronary arteries (heart vessels) causes symptoms of stable or unstable angina pectoris: shortness of breath, dizziness, cold sweats, arrhythmias, and crushing chest pains (which irradiate to the shoulder).

Stenotic atherosclerosis of cerebral arteries leads to cerebral circulatory disturbances, the first signs of which are manifested by frequent dizziness, headaches and facial pain, joined by visual disturbances, sleep and memory problems, transient confusion, personality changes and other symptoms of cerebrovascular ischemia with cumulative damage or death of brain neurons.

See also - Cerebral Atherosclerosis

Atherosclerosis-induced narrowing of the brachial trunk, carotid, subclavian, and vertebral arteries (which supply blood to the upper body, upper extremities, and brain) is defined as stenotic atherosclerosis of the brachiocephalic arteries.When referring to segments of these arterial vessels outside the skull (and brain), the term stenotic atherosclerosis of the extracranial arteries is used, often referring to all arteries that carry blood from the heart to the base of the skull.

For example, stenotic atherosclerosis of the carotid arteries is first manifested by general weakness, noise in the head and flies before the eyes, and then by headaches, nausea, shaky gait, impaired vision and hearing. Read more in the publication - Carotid artery atherosclerosis

Also with stenosis of extracranial arteries to the brain, including vertebral arteries of the neck, there may be sudden numbness of facial muscles, weakness and pain in the upper extremities when moving and impaired fine motor skills, impaired coordination of movements, difficulties with speech. And in cases of atherosclerotic narrowing of the subclavian artery, unilateral tinnitus and hearing impairment are noted; weakening of the pulse on the affected arm and its sensitivity due to impaired blood circulation; pre-syncope and fainting.

Stenotic atherosclerosis of the branches of the aortic arch means atherosclerotic stenosis of its main branches: Brachiocephalic or brachiocephalic trunk (truncus brachiocephalicus), which supplies blood to the right arm and the right side of the head and neck; left common carotid artery (arteria carotis communis), which carries blood to the left side of the neck and head; left subclavian artery (arteria subclavia), which supplies blood to the left upper extremity.

Heaviness in the legs, intense pain, muscle atrophy and paresthesia (numbness) makes itself known stenotic atherosclerosis of the arteries of the lower extremities, which medics call obliterative. It most often affects the superficial femoral and hamstring arterial vessels. Atherosclerosis with narrowing of the lumen of the superficial femoral arteries is the leading cause of ischemic symptoms of the lower extremities, including intermittent claudication and critical limb ischemia. Full story - Atherosclerosis of the Lower Extremity Vessels

What is stenotic atherosclerosis of the major arteries? It is an atherosclerotic lesion of the major arteries such as the coronary, carotid, vertebral, subclavian, iliac, femoral, primal and mesenteric arteries. In stenosing atherosclerosis of the jejunal trunk and mesenteric arteries (superior and/or inferior), blood flow in the intestine is reduced and chronic mesenteric ischemia develops with abdominal pain after meals and weight loss.

But the definition of "local stenotic atherosclerosis" can be used in case of atherosclerotic lesion of a vessel in one place. For example, abdominal or abdominal aorta (aorta abdominalis), the stenosis of which may be manifested by pain in the epigastric region, digestive disorders, paresthesia of the lower extremities, etc. More information - Atherosclerosis of the abdominal aorta and its branches

Or in cases of atherosclerotic renal artery stenosis, symptoms of which include increased blood pressure and swelling of the ankles and feet. [6]

Complications and consequences

Stenosing atherosclerosis may progress to a more severe form with obstruction of the vessel - occlusive or obliterative atherosclerosis (occlusion - complete blockage of the vessel lumen).

The list of severe consequences of stenosing atherosclerosis of the arteries of the heart includes coronary heart disease, as well as the development of acute coronary syndrome and myocardial infarction.

In cases of stenosis of the thoracic part of the aorta, its arch, or the cervical arteries - carotid or vertebral - complications and consequences manifest as transient ischemic attack (microstroke) or ischemic stroke.

Stenotic atherosclerosis of cerebral arteries can also be complicated by stroke. If an aneurysm forms and ruptures, cerebral hemorrhage can cause hemorrhagic stroke with irreversible damage to cerebral structures.

Narrowing of the renal artery with atherosclerosis can lead to chronic renal failure.

Associated with atherosclerosis stenosis of the distal sections of the vessels of the lower extremities, causing tissue ischemia, fraught with the appearance of arterial trophic ulcers on the shins or feet with the threat of tissue necrosis - the development of atherosclerotic gangrene.

Due to the narrowing of the vessel lumen atherosclerosis of the abdominal aorta, the development of its aneurysm is noted, the rupture of which can have fatal consequences. [7]

Diagnostics of the stenosing atherosclerosis

To diagnose atherosclerosis, blood tests are necessary: biochemical, for the level of cholesterol (total and low-density lipoprotein cholesterol), triglycerides, lipids, lipoproteins, apolipoproteins, homocysteine; for the content of serum C-reactive protein and others. [8]

Instrumental diagnostics include:

• ultrasound Doppler ultrasonography of vessels of various localizations;
• Coronarography (coronary angiography);
• CT angiography;
• magnetic resonance angiography. Confirm the diagnosis of ultrasound signs of stenosing atherosclerosis, read more - Deciphering the results of ultrasound Doppler vascular ultrasonography

Differential diagnosis

Differential diagnosis is performed with age-related fibrous involution of aortic wall tissues (non-atheromatous arteriosclerosis); Menkeberg's calcifying arteriosclerosis; aortitis; autoimmune obliterative endarteritis; amyloid and diabetic angiopathy; vertebrobasilar syndrome in cervical spine osteochondrosis, metabolic and endocrine encephalopathies etc.

Treatment of the stenosing atherosclerosis

To stabilize atherosclerotic plaques in the treatment of stenosing atherosclerosis, blood cholesterol-lowering statins and drugs from the group of selective cholesterol absorption inhibitors are used, [9], [10] for more information see:

• Treatment of high cholesterol
• Pills for high cholesterol

More information in the articles:

• Atherosclerosis - Treatment
• How to lower blood cholesterol without medication?

You should also follow diet for atherosclerosis.

For surgical treatment of atherosclerotic stenoses, read:

• Endovascular dilatation (angioplasty)
• Coronary artery stenting

Prevention

Is it possible to prevent the development of stenosing atherosclerosis? This requires prevention of atherosclerotic lesions of blood vessels, including a healthy and more mobile lifestyle (without bad habits such as smoking and overeating), normalization of weight, as well as proper nutrition.

Forecast

According to experts, it is difficult to give a prognosis for such a multifactorial systemic disease as atherosclerosis. And if the patient has stenotic atherosclerosis, it is even more difficult to predict its outcome.

And it should be taken into account that stenosis of carotid arteries of atherosclerotic etiology accounts for up to 20% of strokes, and stenosing atherosclerosis of coronary arteries - more than half of deaths in its complication in the form of myocardial infarction.