Treatment of atherosclerosis of the carotid arteries

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

• Nicotinic acid and drugs based on it lower the level of triglycerides and cholesterol in the bloodstream, increase the presence of high-density lipoproteins, which have anti-atherogenic properties. Nicotinic acid should not be prescribed to people suffering from liver failure.
• Fibric acid derivatives (fibrates: Gevilan, Atromid, Miskleron) reduce the production of lipids in the body. Their use is undesirable for patients with hepatic insufficiency and cholelithiasis.
• Bile acid sequestrants (Cholestyramine, Cholestide) promote the removal of bile acids and cholesterol from the intestine, reducing their content in cells. Side effects of these drugs can be constipation and bloating.
• Lipid-lowering drugs, 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 because cholesterol production rises at night. Long-term use of these drugs can cause various hepatic impairments.

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

• The method of hemosorption, in which blood is passed through adsorbing filters, is a special device outside the body. Filters help to “pick up” plasma atherogenic lipoproteins from the blood. The disadvantage 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 is the replacement of the patient's blood plasma with blood substitutes or other blood preparations.
• The plasma sorption method involves the sorbent purification of the patient's plasma and its further return to the circulatory system.

The use of these techniques helps to temporarily correct lipid profile indicators, however, 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.

Medications

Statins lower cholesterol levels, thereby reducing coronary lethality. Contraindications to taking statins are: pregnancy, acute liver or kidney failure, allergies, childhood. Side effects during treatment can be: diarrhea, bloating, nausea, exacerbation of pancreatitis, headache, convulsions, myopathy, 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, it is possible to increase the dosage to 40 mg or more, at the discretion of the doctor.
• Simvastatin  lowers blood cholesterol levels. Usually begin with a dosage of 5-10 mg daily in the evening, with a possible further increase in this amount.
• Pravastatin inhibits the biosynthesis of cholesterol in the liver. The initial dose of the drug is 10-20 mg daily at bedtime. If the expected effect is not found, 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 admission. The initial amount of the drug is 20 mg per day. If the cholesterol level is greatly elevated, then the dose is increased to 40 mg / day.
• Atorvastatin effectively lowers cholesterol levels, which becomes noticeable after 2 weeks of use. The maximum effect is found 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 has been successfully used to treat adult patients with carotid atherosclerosis, regardless of gender and age. The initial dose is 5-10 mg per day, with a maximum daily amount of 40 mg.

Fibrates are able to normalize the level of triglycerides, 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 can be dyspepsia, itching, swelling, the formation of gallstones (especially characteristic of Clofibrate, or Lipamide).

• Bezafibrate is taken for several years (on average 2-4 years) at 0.2 g three times a day or as a prolonged preparation of 0.4 g once a day. Bezafibrate has no hepatotoxic effect.
• Fenofibrate reduces the level of uric acid and "bad" cholesterol. Take 0.1 g in the morning and evening, or 0.2 g only in the evening.
• Ciprofibrate - often prescribed for hyperlipoproteinemia, 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 a photoactivation effect. 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 who are not responding well to medical therapy and who cannot perform balloon angioplasty or bypass surgery. The procedure is contraindicated if the patient has uncontrolled hypertension, pronounced cardiac arrhythmias, valvular 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 the activation of the release of vascular growth factors and the optimization of blood circulation. [7]

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

Herbal treatment

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

• A mixture of dried lemon balm plants,  [9]Chinese or Siberian motherwort  [10]and cinquefoil  [11]is used as an infusion, drinking several sips during the day.
• A mixture of wild rose berries  [12],  [13]motherwort, meadowsweet  [14], and cudweed  [15](1 tsp each) is poured into 0.5 liters of boiling water, insisted for 8 hours. Drink the drug 100 ml three times a day for two months.
• Three tablespoons of a collection of red clover,  [16]wormwood,  [17]parsley  [18]root  [19]and marjoram are poured with 1 liter of boiling water, kept for about 3 hours under the lid. Drink an infusion of 50 ml every 2 hours for a week. Then they take a week break and continue treatment again.
• A mixture is prepared from the leaves of lemongrass, eleutherococcus,  [20]mint, burdock,  [21]cudweed, white birch bark  [22]and rose hips. Two tablespoons of the mixture pour 500 ml of boiling water, insist until cool. Take 100 ml three times a day.

Phytotherapy experts recommend drinking an infusion daily for atherosclerosis of the carotid arteries using at least one of the following plants:

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

In addition to these plants, garlic, lemon juice, ground horseradish, onions, wild garlic should be added to the diet of patients - these are well-known alternative means to inhibit the development of atherosclerosis.

Diet for atherosclerosis of the carotid arteries

Some changes in lifestyle and nutrition sometimes have a greater effect on atherosclerosis of the carotid arteries than taking medication. It is important to adhere to the following nutritional principles:

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

These changes in nutrition allow relatively quickly to normalize the lipid level at any stage of the disease.

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

It is important that a slight decrease in the amount of fatty foods consumed does not affect the course of atherosclerosis in any way: stabilization of the condition and slowing down of the pathological process occurs only after limiting the intake of fats to 20 g / day, including 6-10 g of polyunsaturated fats with omega-6 and omega-3 fatty acids. Acids. Trans fats should be avoided altogether.

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

Vegetable food in the form of fruits and vegetables should be part of the five meals daily. Vitamins, vegetable fiber and flavonoids, substances contained in dark grapes and black tea, have a good protective effect on blood vessels.

Doctors recommend daily consumption of at least 5-10 g of water-soluble fibers (bran, legumes, soybeans): even such a small amount reduces the level of "bad" cholesterol by 5%. Non-water-soluble fibers have a less pronounced effect on cholesterol levels, but also have a number of useful properties - for example, reduce the risk of bowel cancer.  [26]A recent meta-analysis of three randomized controlled trials found that supplementation with gel-forming viscous soluble fiber doubled the efficacy of statins. [27]

Alcoholic drinks in small volumes also have a protective effect on blood vessels, but this applies to really small dosages - 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 consumed 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), it was assumed that 4 oz (118 ml) of wine contained 10.8 g, 12 oz (355 ml) of beer contained 13.2 g, and 1.5 oz (44 ml) contain liquor contains 15.1 g of ethanol. Subsequently, grams of ethanol were converted to drinks per week (14 g of alcohol = 1 drink). [28]

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

Surgery

If a patient has an advanced stage of atherosclerosis of the carotid arteries, and drug treatment does not lead to a positive result, then the question may be raised about the use of surgical treatment, during which it is possible to perform such interventions:

• The operation of carotid endarterectomy involves the removal of atherosclerotic layers from the affected vessel. [29]
• Balloon angioplasty may be prescribed if there are contraindications to carotid endarterectomy, or if there is no adequate access to atherosclerotic layers. 
• The operation of stenting involves the introduction of 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 danger or development of blockage of the carotid artery with atherosclerotic layers or a thrombus. It is allowed to carry out an open operation (endarterectomy) or endovascular intervention, with arterial dilatation in the area of vasoconstriction.

Carotid surgery for atherosclerosis

To date, there are no "magic" medicines that could bind and remove atherosclerotic layers from the carotid arteries. Thanks to drugs, it is only possible to slow down the development of atherosclerosis, reduce the risk of thrombosis. The only way to expand the arterial lumen and eliminate layers is to perform an operation, 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.

With atherosclerosis of the carotid arteries, the most common operation is the eversion carotid endarterectomy, which is carried out in stages:

1. The doctor makes anesthesia (often we are talking about conduction anesthesia), then in the neck area in the area of the projection of the carotid artery makes an incision of about 5 cm.
2. Using a three-fold increase, with the help of special tools, the surgeon separates the arteries from adjacent structures (venous vessels, nerves, etc.).
3. Performs a test of the resistance of the brain to temporary blockage of an arterial vessel. There are a number of ways to do this. If the test shows that the brain is not ready to endure the blockage of the blood flow, then the doctor performs a special temporary bypass to ensure the blood supply to the carotid pool, which is being operated on. Next, the doctor pinches the necessary vessels.
4. It dissects the internal carotid artery in the transverse direction, inverts the outer side of the vessel and removes the atherosclerotic plaque from its wall along with the inner layer.
5. Gently removes all other "free" layers, returns the outer layer of the artery to its original position.
6. Restores the integrity of the carotid artery with a continuous suture using thin non-absorbable sutures.
7. Removes air from the artery and restores blood flow. Checks the tightness of the suturing and the absence of bleeding, suturing the wound in layers 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 in atherosclerosis of the carotid arteries

Gradual tempering procedures and regular physical activity reduce the likelihood of a negative impact of risk factors: it is useful to take air baths and a contrast shower, walk for 30-40 minutes a day, and swim. The presence of a clear causal relationship between an active and healthy lifestyle and a slowdown in the course 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 exercises help strengthen blood vessels and normalize body weight. Important: before starting hardening or physical activity in case of atherosclerosis of the carotid arteries, you should first undergo a complete examination by a specialist. In addition, hardening procedures should be built up gradually and have a definite and constant regimen. The patient should prepare for a long system, avoid sudden changes in temperature, which is stressful for the body. It is important to start gradually with further regular maintenance of the result. A person suffering from atherosclerosis should understand that the reaction to a sharp effect of cold water is the same sharp vasoconstriction. A compensatory reaction occurs, in which blood rushes to the internal organs, and the heart has to pump large volumes of blood faster. With atherosclerosis of the carotid arteries, the vessels cannot respond as quickly and at the same time smoothly to temperature changes, and the result may be unfavorable. For example, if an elderly patient has never practiced hardening and at one moment decided to douse himself with ice water, then there will be no benefit from such a procedure.

Normal hardening is a gradual start with minimal temperature fluctuations and regular practice. It is preferable to start with air baths, rubdowns, contrast showers. In case of atherosclerosis of the carotid arteries, it is imperative to first consult a doctor and go through the entire range of examinations.

Gymnastics for atherosclerosis of the carotid arteries

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

1. Walking at an average pace, duration - up to 3 minutes: 2 steps - inhale, 3 steps - exhale.
2. Starting position: the patient is standing, legs together, hands on the belt, back is straight, shoulders are deployed. On exhalation, draws in the stomach, on inspiration, protrudes it as much as possible. Repeats 4 times.
3. The patient is sitting on a chair. Clenches and unclenches his fingers, gradually raising his hands up. Repeats 4 times in slow motion. At the end, he shakes his brushes.
4. The patient sits on a chair, legs extended in front of him and spread apart shoulder width apart. Rotates the ankle joints 10 times in each direction, at an average pace.
5. The patient sits on a chair, synchronously bends and unbends his 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 his knees. He puts one hand behind his head, and the other behind his lower back, then vice versa. Alternate movements of the right and left hand, repeating 4 times.
7. Performs walking in place for three minutes.
8. Performs up to 5 squats at an average pace, using support (chair).
9. Using a support, he takes his 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 is standing, arms along the body. Performs body tilts to the right and left, in each direction 4 times.