Treatment of carotid atherosclerosis

Conservative treatment of carotid artery atherosclerosis usually includes the following categories of medications:

• Nicotinic acid and drugs based on it reduce the level of triglycerides and cholesterol in the bloodstream, increase the presence of high-density lipoproteins, which have antiatherogenic properties. Nicotinic acid should not be prescribed to people suffering from liver failure.
• Fibric acid derivatives (fibrates: Gevilan, Atromid, Miskleron) reduce lipid production in the body. Their use is undesirable for patients with liver failure and cholelithiasis.
• Bile acid sequestrants (Cholestyramine, Cholestide) help remove bile acids and cholesterol from the intestines, reducing their content in cells. Side effects of such drugs may include constipation and bloating.
• Hypolipidemic agents, HMG-CoA reductase inhibitors, statins (Pravachol, Mevacor, Zocor) – reduce the level of “bad” cholesterol, inhibit its production in the body. Statins should be taken in the evening, since cholesterol production increases at night. With prolonged use, these drugs can cause various liver dysfunctions.

According to indications, it is possible to use so-called extracorporeal techniques to improve lipid metabolism. Such methods normalize the composition of blood and lymph, purifying them:

• A method of hemosorption, in which blood is passed through adsorbing filters - a special device outside the body. Filters help "take" plasma atherogenic lipoproteins from the blood. The downside of this method is the simultaneous removal of some blood elements and "good" cholesterol from the bloodstream.
• The immunosorption method involves the use of an immunosorbent, which, unlike hemosorption, removes only atherogenic lipoproteins (LDL).
• The plasmapheresis method involves replacing the patient's blood plasma with blood substitutes or other blood products.
• The plasma sorption method involves sorbent purification of the patient's plasma and its subsequent return to the circulatory system.

The use of these techniques helps to temporarily correct the lipidogram indicators, but frequent or prolonged such treatment can change the protein composition of the blood, deprive the body of many immune factors. Another disadvantage is the short effect of the procedures, the need for their regular repetition, as well as the high cost.

Medicines

Statin drugs help lower cholesterol levels, thereby reducing coronary mortality rates. Contraindications to taking statins include pregnancy, acute liver or kidney failure, allergies, and childhood. Side effects during treatment may include: diarrhea, bloating, nausea, exacerbation of pancreatitis, headache, seizures, myopathy, and allergic reactions. [ 1 ]

• Lovastatin – helps prevent the development of the first coronary attack and unstable angina. At the initial stage of treatment, 20 mg of the drug is prescribed daily in the evening. After a month, the dosage may be increased to 40 mg or more, at the discretion of the doctor.
• Simvastatin reduces cholesterol levels in the blood. Usually, the dose is started at 5-10 mg daily in the evening, with possible further increases in this amount.
• Pravastatin inhibits cholesterol biosynthesis in the liver. The initial dose of the drug is 10-20 mg daily before bedtime. If the expected effect is not observed, the dosage is increased to 40 mg.
• Fluvastatin is a drug that does not penetrate the blood-brain barrier. The therapeutic effect is detected after 4 weeks of administration. The initial dose of the drug is 20 mg per day. If the cholesterol level is greatly increased, the dose is increased to 40 mg/day.
• Atorvastatin effectively reduces cholesterol levels, which becomes noticeable after 2 weeks of use. The maximum effect is detected after a month of treatment. The drug is taken orally at 10 mg in the evening. Increasing the dosage is discussed with the doctor.
• Rosuvastatin is successfully used to treat adult patients with carotid artery atherosclerosis, regardless of gender and age. The initial dose is 5-10 mg per day, with a maximum daily dose of 40 mg.

Fibrate drugs are able to normalize the level of triglycerides by reducing their synthesis in the body. Fibrates are not prescribed to patients with liver and kidney diseases, as well as to women during pregnancy and lactation. Possible side effects may include dyspepsia, skin itching, edema, and the formation of gallstones (especially characteristic of Clofibrate or Lipamid).

• Bezafibrate is taken for several years (on average 2-4 years) at 0.2 g three times a day or as a prolonged-release drug 0.4 g once a day. Bezafibrate does not have a hepatotoxic effect.
• Fenofibrate reduces uric acid and "bad" cholesterol levels. Take 0.1 g in the morning and evening, or 0.2 g in the evening only.
• Ciprofibrate is often prescribed for hyperlipoproteinemia at 0.1 g 1-2 times a day.
• Gemfibrozil – successfully lowers triglyceride levels. Take 0.3-0.45 g twice a day.

Physiotherapy treatment

Laser irradiation of blood has a positive biological effect in the form of photoactivation. Under the influence of irradiation, the contractile activity of the myocardium is optimized, the intensity and frequency of ischemic attacks are reduced, and the lipid composition of the blood is improved. The procedure can be intravenous, intra-arterial and percutaneous. [ 2 ], [ 3 ], [ 4 ], [ 5 ]

It is possible to use hardware methods – in particular, enhanced external counterpulsation and shock wave therapy. These methods are successfully used as an additional treatment for atherosclerosis in many cardiology centers.

Enhanced external counterpulsation is used in patients with severe angina, with insufficient effect from drug therapy and the impossibility of performing balloon angioplasty or bypass. The procedure is contraindicated if the patient has uncontrolled hypertension, severe cardiac arrhythmia, valve defects, thrombophlebitis. [ 6 ]

Shock wave therapy involves the use of low-intensity shock waves generated by a wave generator to provide tension to the vascular wall. The procedure causes activation of the release of vascular growth factors and optimization of blood circulation. [ 7 ]

Small clinical trials have shown promising results regarding the potential use of ultrasound-enhanced thrombolysis in acute cerebral ischemia.[ 8 ] Furthermore, the combination of intravenous gas microspheres (microbubbles) with ultrasound has been shown to be a potential alternative for recanalization of intravascular thrombi.

Herbal treatment

Many medicinal plants help to stop the development of atherosclerosis of the carotid arteries. A combination of herbs is especially useful - the so-called medicinal collections, which have a complex effect on the cerebral vascular network and the cardiovascular system as a whole. The following complex recipes have proven themselves to be excellent:

• A mixture of dried lemon balm plants, [ 9 ] Chinese or Siberian motherwort [ 10 ] and cinquefoil [ 11 ] is used in the form of an infusion, drinking several sips throughout the day.
• A mixture of rose hips, [ 12 ], [ 13 ] motherwort, meadowsweet [ 14 ], and immortelle [ 15 ] (1 teaspoon each) is poured into 0.5 l of boiling water and infused for 8 hours. Drink 100 ml of the remedy three times a day for two months.
• Three tablespoons of a mixture of red clover, [ 16 ] wormwood, [ 17 ], [ 18 ] parsley root [ 19 ] and marjoram are poured with 1 liter of boiling water and kept under a lid for about 3 hours. Drink the infusion 50 ml every 2 hours for a week. Then take a week's break and continue the treatment again.
• Prepare a mixture of lemongrass leaves, eleutherococcus, [ 20 ] mint, burdock, [ 21 ] immortelle, white birch bark [ 22 ] and rose hips. Pour 500 ml of boiling water over two tablespoons of the mixture and leave to infuse until cool. Take 100 ml of the remedy three times a day.

Phytotherapy specialists recommend drinking an infusion daily for atherosclerosis of the carotid arteries using at least one of the plants listed below:

• Clover – helps eliminate atherosclerotic deposits against the background of dietary correction.
• Mint – helps cleanse the body. Leaves can be added not only to infusions and tea, but also to salads and first courses.
• Dandelion Roots and Leaves – An infusion of the plant reduces serum triglyceride levels, total cholesterol, LDL-C and increases HDL-C. [ 23 ], [ 24 ]
• Burdock leaves – strengthen blood vessels, rejuvenate the circulatory system.
• Flax seeds – hypolipemic effect, reduces TG levels, reduces Lp(a) levels by 14% after 10 weeks of intake. [ 25 ]
• Fennel seeds – improve blood circulation, cleanse blood vessels.

In addition to the above plants, it is essential to add garlic, lemon juice, ground horseradish, onions, and wild garlic to the diet of patients - these are well-known folk remedies for slowing the development of atherosclerosis.

Diet for atherosclerosis of the carotid arteries

Some lifestyle and dietary changes can sometimes have a greater effect on carotid atherosclerosis than medication. It is important to follow these dietary guidelines:

• reduce your intake of saturated fats to a minimum;
• eliminate trans fats completely;
• reduce your intake of refined carbohydrates to a minimum;
• significantly increase the proportion of plant foods and fiber in the diet;
• severely limit alcohol consumption.

The indicated changes in nutrition allow for relatively rapid normalization of lipid levels at any stage of the disease.

In addition, the diet involves reducing the consumption of fat-containing products (meaning animal fat) - no more than 10% of the daily caloric content of food. The total number of kilocalories should also be limited - up to 2500 kcal / day (if the patient is obese, then the daily caloric content is calculated by a nutritionist).

It is important that a small reduction in the amount of fatty foods consumed does not affect the course of atherosclerosis: stabilization of the condition and slowing of the pathological process occurs only after limiting fat consumption to 20 g / day, including 6-10 g of polyunsaturated fats with omega-6 and omega-3 fatty acids. Trans fats should be excluded altogether.

A large amount of simple carbohydrates in the diet contributes to an increase in triglyceride levels and reduces the level of high-density triglycerides in the blood serum. It turns out that the lack of calories should be replenished not with carbohydrate foods, but with protein foods, with sufficient intake of unsaturated fats. It is also recommended to pay attention to high-quality complex carbohydrates: cereals, grains, vegetables.

Plant foods in the form of fruits and vegetables should be included in five meals daily. Vitamins, plant fiber and flavonoids – substances contained in dark grapes and black tea – have a good protective effect on blood vessels.

Doctors recommend consuming at least 5-10 g of soluble fiber (bran, legumes, soy) daily: even such a small amount reduces the level of “bad” cholesterol by 5%. Insoluble fiber has a less pronounced effect on cholesterol levels, but also has a number of beneficial properties - for example, it reduces the risk of developing bowel cancer. [ 26 ] A recent meta-analysis of three randomized controlled trials showed that adding gel-forming viscous soluble fiber to food doubles the effectiveness of statins. [ 27 ]

Alcoholic beverages in small amounts also have a protective effect on blood vessels, but this applies to really small doses - no more than 1 ounce of alcohol 5 times a week.

In one prospective study of 14,629 adults aged 45–64 years, researchers found that participants who drank up to 7 drinks per week had a lower risk of developing heart failure compared to those who did not drink. When calculating the amount of alcohol consumed (in g/week), 4 ounces (118 ml) of wine contained 10.8 g, 12 ounces (355 ml) of beer contained 13.2 g, and 1.5 ounces (44 ml) of liquor contained 15.1 g of ethanol. Grams of ethanol were then converted to drinks per week (14 g of alcohol = 1 drink). [ 28 ]

Higher doses have the opposite effect and lead to additional health problems.

Surgical treatment

If a patient is diagnosed with advanced stage carotid artery atherosclerosis and drug treatment does not produce positive results, the question of surgical treatment may be raised, during which the following interventions may be performed:

• Carotid endarterectomy surgery involves removing atherosclerotic plaque from the affected vessel. [ 29 ]
• Balloon angioplasty may be indicated if there are contraindications to carotid endarterectomy or if there is inadequate access to atherosclerotic deposits.
• Stenting surgery involves inserting a special stent into the carotid artery – a small metal device that expands the vascular lumen and restores normal blood circulation. [ 30 ]

The appointment of surgical intervention is justified if there is a risk or development of blockage of the carotid artery by atherosclerotic deposits or a thrombus. Open surgery (endarterectomy) or endovascular intervention with arterial dilation in the area of vascular narrowing is allowed.

Carotid artery surgery for atherosclerosis

Today, there are no "magic" medications that could bind and remove atherosclerotic deposits from the carotid arteries. Thanks to medications, it is only possible to slow down the development of atherosclerosis and reduce the risk of thrombus formation. The only way to widen the arterial lumen and remove deposits is to perform surgery, which, however, is not indicated for all patients. There are strict indications for surgical intervention when the artery is critically narrowed, and drug treatment does not have the necessary positive effect.

For atherosclerosis of the carotid arteries, the most common operation is eversion carotid endarterectomy, which is performed in stages:

1. The doctor administers anesthesia (often this is a conduction anesthesia), then makes an incision of about 5 cm in the neck area in the projection zone of the carotid artery.
2. Using three-fold magnification and special instruments, the surgeon separates the arteries from adjacent structures (venous vessels, nerves, etc.).
3. Performs a test of the brain's resistance to temporary occlusion of an arterial vessel. There are a number of ways to do this. If the test shows that the brain is not ready to tolerate the occlusion of blood flow, the doctor performs a special temporary bypass to ensure blood supply to the carotid artery basin on which the operation is being performed. The doctor then clamps the necessary vessels.
4. Dissects the internal carotid artery transversely, turns the outer side of the vessel inside out and removes the atherosclerotic plaque from its wall along with the inner layer.
5. Carefully removes all other “free” layers, returning the outer layer of the artery to its previous position.
6. Restores the integrity of the carotid artery using continuous sutures, using thin non-absorbable threads.
7. Removes air from the artery and restores blood flow. Checks the tightness of the suturing and the absence of bleeding, sutures the wound layer by layer using a cosmetic suture.

During the entire intervention, the patient is conscious, the surgeon regularly checks visual and speech interaction. In general, the operation can last from 1 to 2 hours. The duration of the postoperative period varies, depending on the specific organism.

Hardening for atherosclerosis of the carotid arteries

Gradual hardening procedures and regular physical activity reduce the likelihood of negative impact of risk factors: it is useful to take air baths and contrast showers, walk for 30-40 minutes a day, swim. The presence of a clear cause-and-effect relationship between an active and healthy lifestyle and a slowdown in the progression of atherosclerosis has been proven. [ 31 ]

The optimal duration, frequency, intensity and type of physical activity, as well as options for hardening procedures are determined individually. Such activities help strengthen blood vessels and normalize body weight. Important: before starting hardening or physical activity for atherosclerosis of the carotid arteries, you should first undergo a full examination by a specialist. In addition, hardening procedures should be built up gradually and have a specific and constant regime. The patient should be prepared for a long system, avoid sudden changes in temperature, which is stressful for the body. A gradual start with further regular maintenance of the result is important. A person suffering from atherosclerosis should understand that the reaction to the sudden effect of cold water is the same sharp narrowing of the vessels. A compensatory reaction occurs, in which blood flows to the internal organs, and the heart has to pump larger volumes of blood faster. With atherosclerosis of the carotid arteries, the vessels cannot react to temperature changes as quickly and smoothly, and the result may be unfavorable. For example, if an elderly patient has never practiced hardening and at one point decides to douse himself with ice water, there will be no benefit from such a procedure.

Normal hardening is a gradual start with minimal temperature changes and regular practices. It is preferable to start with air baths, rubdowns, contrast showers. In case of atherosclerosis of the carotid arteries, it is necessary to consult a doctor in advance and undergo a full range of examinations.

Gymnastics for atherosclerosis of the carotid arteries

To stop the development of carotid artery atherosclerosis, it is very important to provide all the conditions for improving the blood supply to the brain. For this, experts advise frequent walks in the fresh air, regularly doing gymnastics with moderate physical activity. The following exercises are considered the most suitable:

1. Walking at a medium pace, duration – up to 3 minutes: 2 steps – inhale, 3 steps – exhale.
2. Initial position: the patient stands, feet together, hands on the waist, back straight, shoulders out. On exhalation, pulls in the stomach, on inhalation, pushes it out as much as possible. Repeats 4 times.
3. The patient sits on a chair. Squeezes and unclenches the fingers on his hands, gradually raising his hands up. Repeats 4 times in slow motion. Finally, shakes the hands.
4. The patient sits on a chair, legs stretched out in front of him and spread shoulder-width apart. Rotates the ankle joints 10 times in each direction, at a medium pace.
5. The patient sits on a chair, synchronously bends and straightens the arms and legs at the elbows, shoulders and knees (imitation of walking). Performs 10 times at an average pace.
6. The patient sits on a chair, feet on the floor, hands on the knees. Places one hand behind the head, and the other behind the waist, then vice versa. Alternates movements with the right and left hand, repeating 4 times.
7. Performs walking in place for three minutes.
8. Performs up to 5 squats at a moderate pace using support (chair).
9. Using support, moves the left arm and right leg to the side, then vice versa. Repeats 4 times.
10. From the position "lying on the floor" on the stomach, arches the back (hands behind the head). Repeats 3-5 times.
11. Raises the right leg, bent at the knee joint, and touches it with the elbow of the left hand, then vice versa. Performs 3-4 repetitions.
12. The patient stands with his arms along the body. He bends his body to the right and to the left, to each side 4 times.