Atherosclerosis of the main arteries is a disease that is chronic in nature and manifests itself in narrowing of the lumen or complete blockage of the blood vessels of the head, neck and limbs. It is accompanied by the formation of atherosclerotic plaques (lipid infiltrations) due to calcification and proliferation of connective tissue. This ultimately leads to insufficient blood circulation in the brain or limbs.
Atherosclerosis, affecting the main arteries of the lower extremities, is observed most often. Mostly, this pathology manifests itself in men who have crossed the age limit of 40 years. But after a woman enters the postmenopausal period, the chances of developing atherosclerosis in both sexes are equalized. The same applies to atherosclerosis of the main arteries of the head and neck.
Symptoms of atherosclerosis of the main arteries
Depending on which major arteries were damaged by atherosclerosis, the symptoms of the disease will vary.
If we are talking about damage to the arteries of the brain, then a person will experience:
Attacks of headache and dizziness of varying intensity,
Difficulty falling asleep, waking up in the middle of the night, feeling sleepy during the daytime amid general overwork,
Decrease in short-term memory,
Change in character traits, the appearance of tearfulness, increased levels of anxiety, excessive suspicion and emotional lability,
Gait and speech disorders, as well as other neurological disorders.
When atherosclerosis affects the main arteries of the upper and lower extremities, this will manifest itself as follows:
With damage to the arteries of the lower extremities, a person most often suffers from intermittent claudication,
The feeling of fatigue from walking comes much earlier, the passage of a long section of the path becomes a laborious activity,
There is dystrophy of the nail plates, hair loss on the legs, a decrease in calf muscles in size.
Gangrene of the extremities is the apogee of the development of the disease,
Reduction of pulsation in the arteries,
If the arteries of the upper extremities are primarily affected, then a person experiences cold in the hands, ulcers can form, and small wounds will bleed for a long time.
What is atherosclerosis of the great vessels
Atherosclerosis of the main vessels of the head is an insidious pathology, which is characterized by the deposition of fat cells on the walls of the arteries of the brain in the form of stenotic plaques. Atherosclerotic plaque blocks partially or completely the lumen of the arterial ring of the brain, which negatively affects the cerebral blood flow.
Over time, pathological changes in the vessels of the brain lead to a chronic violation of the blood flow in its arteries. As a result of this, the vascular bed undergoes significant negative changes, up to the complete blockage of its lumen. This is due to the symptoms that are characteristic of this disease.
Symptoms and possible complications
At the initial stage clinical signs may be mild or completely absent.
With progression Atherosclerosis of the main cerebral arteries, patients begin to notice the following symptoms:
- constant pain in the head area that occurs for no apparent reason,
- due to destabilization of pressure, dizziness appears, which often lead to a short-term loss of consciousness,
- problems falling asleep and the depth of sleep,
- in severe cases, more serious neurological problems are observed: speech impairment, pathological gait changes, inadequate behavioral reactions, cognitive-mnemonic function disorder.
Atherosclerosis extracranial segments The main arteries of the head become a cause of decreased function of short-term memory. Chronic disorder of arterial blood flow in the brain leads to various stages of discirculatory encephalopathy. Even non-stenotic forms of atherosclerosis of the main cerebral arteries often cause serious complications. The most common of these is ischemic stroke (cerebral infarction). A severed fat plaque completely obstructs the lumen of the artery, which leads to the cessation of blood flow in this part of the brain. After a few hours, irreversible ischemia develops, which becomes the cause of the appearance of focal neurological symptoms.
Causes of occurrence and development
The main reason that causes major atherosclerosis is considered excess cholesterol in blood. Under the influence of adverse factors, the utilization of cholesterol in the liver is impaired, and it adheres to the inner lining of blood vessels, including the main arteries of the brain. There are risk factors for the development of hypercholesterolemia, and, accordingly, of major atherosclerosis: excessive drinking, smoking tobacco or hookah, frequent intake of excessively fatty foods, physical inactivity, chronic stress, impaired sleep and wakefulness, lack of regular cardiac loads.
Carbohydrate metabolism also often provokes the development of lipid metabolism pathology, which soon leads to atherosclerosis of the main cerebral vessels.
The risk of becoming a victim of major atherosclerosis is exposed to the stronger sex, who have crossed the forty-year milestone. The weaker sex risks getting this disease at the age of fifty. This difference is due to the characteristics of the female hormonal background.
Causes of Atherosclerosis
The disease has a whole host of factors provoking the leading cause of atherosclerosis - the occurrence of cholesterol deposits.
These factors include: the appearance of persistent hypertension, heart and vascular disease, alcohol abuse, smoking, high blood lipids, diabetes mellitus, excessive body weight, physical inactivity, high stress levels, bad eating habits, malfunctioning of the endocrine glands, age factor.
Atherosclerosis of cerebral vessels of the brain is more common than damage to blood elements outside the cranium. This occurs due to structural features of the vessels of the brain.
The walls of the cerebral arteries of the head are much thinner than other arteries, therefore, atherosclerosis progresses more rapidly and affects large areas.
Cholesterol deposits formed in different departments of the main arteries also have their own characteristics. For example, atherosclerosis of extracranial segments of the main arteries of the head is characterized by fibrotic and stenotic neoplasms.
In the main vessels, plaques contain less lipid units and more collagen, and carotid ones have approximately the same level of collagen and fat inclusions.
If the integrity of the plaques containing many lipids is damaged, the risk of rupture or complete separation from the vessel wall is high. This threatens the development of: coronary heart disease, atherothrombotic stroke, thromboembolism.
Signs of pathology
When atherosclerosis of cerebral arteries occurs, a person develops concomitant symptoms.Patients do not identify the first signs with vascular problems, and therefore, at the initial stage of the development of the disease, they do not pay attention to pathology, which leads to aggravation of symptoms.
Among the signs of the disease include:
- the appearance of a severe headache, the occurrence of attacks of weakness and dizziness. In this case, the headache is typical, in fits, it can appear at any time, regardless of the time of day or night. The power of dizziness is also different - from mild malaise to loss of consciousness,
- noise in ears - uncomfortable sensations either appear or disappear, may intensify when the head is tilted, during bouts of headache and dizziness,
- constant weakness - From her comes fatigue, there is a feeling of irresistible drowsiness, which lasts all day. Patients suffer from insomnia, often wake up,
- if cerebral arteriosclerosis affects extracranial arteries, then people can even suffer short amnesia,
- emotional disorders - patients become too tearful or passive, they are tormented by anxiety, fears, suspicion,
- neurological abnormalities, manifested in behavioral disorders, problems with movements.
The World Health Organization has developed a classification of the disease, according to which three stages of development can be distinguished.
First stage with atherosclerosis mage. blood vessels characterized by minor disturbances. It is called the lipid spot stage. Lipid spots, as a rule, do not manifest themselves in any way, so patients are not even aware of such violations.
If you look at the spot under the microscope, it can look like a strip or a round dot, which only rises slightly above the surface, and sometimes even merges with it completely.
Second stage wears name of fibrous plaque. In this case, cholesterol deposition does not just appear on the artery wall, but protrudes significantly from its wall into the lumen of the blood vessel. This disorder can already be classified as a disease.
Externally, plaques are deposits of light color - from white to yellow with a pearly sheen. They have an oval or round shape, various heights and lengths along the vessel. Inside, such a plaque contains a certain amount of lipids, but the surface is pulled by a fibrous or collagen membrane.
If such a plaque covers up to 60 percent of the lumen of the vessel, then there are no violations in the state of health from it and the person feels satisfactory. At the closure of the lumen, more than 60 percent already significantly affects blood circulation, the medulla suffers from a lack of nutrition and oxygen.
In the third stage complex plaques appear in a person’s disease These are deposits with hemorrhages - hematomas, calcification, as well as those that provoke ulcers on the walls of blood vessels. When the pathology goes from the second to the third stage, a person has a risk of a heart attack, stroke, embolism (changes in the direction of blood flow).
Atherosclerosis mage it is not easy to diagnose vessels. A patient with health problems needs to consult a doctor, conduct a hardware diagnosis of pathology.
Diagnosis of the disease at the first stage includes a general examination of the patient and the collection of general data. In the future, the patient will undergo an ultrasound examination of the vessels of the brain. Additionally, the doctor will recommend magnetic resonance imaging, which clarifies the picture of cerebral blood flow disorders.
If a small degree of atherosclerotic changes in the great vessels is detected, patients need long-term treatment, and not only medications will be prescribed.The patient needs:
- change lifestyle, include physical activity in your daily routine,
- get rid of bad habits,
- enrich the diet with herbs, fruits, dairy products.
Medications for patients will be prescribed from various groups:
- Cardiomagnyl or Plavix can be taken as antiplatelet drugs,
- Sulodexide is suitable for blood thinning,
- To improve peripheral blood circulation in the brain, patients are recommended nicotinic acid,
- to activate collateral communication, you can take Actovegin,
- in order to normalize cholesterol levels, Krestor is recommended for patients, it is also possible to take nicotinic acid.
This list of drugs is only an example and most often used. Depending on the individual characteristics of the patient, his condition, stage of the disease, the list of medications can be adjusted.
In addition, patients are recommended long-term use of acetylsalicylic acid, which reduces the risk of blood clots.
Surgical treatment of the disease is performed if conservative methods of treatment are ineffective, and atherosclerotic lesions of the vessels capture the lumen of the artery of the brain more and more. Surgical treatment of the brain artery is carried out only if no more than three main vessels are affected. With a total lesion, surgery is ineffective.
Doctors can perform two types of operations - the first is performed through a small puncture, and the second through an incision. With endovascular surgery, even advanced atherosclerosis can be cured. Surgery takes place by inserting a catheter through the femoral artery and installing it into the problematic main cerebral vessel.
The stent - the so-called design - is a mesh spring, which, under its inertia, presses the cholesterol plaque into the walls of the vessel.
Classical surgery involves shunting a brain artery or replacing a vessel with another, healthy section of the artery. After the operation, patients are recommended to take blood thinners, follow a diet, eat less foods containing a high percentage of fat.
As soon as the period of postoperative rehabilitation ends, the patient is allowed to add dosed physical activity. It is recommended to be observed by specialist doctors, once a year to undergo examination of the great vessels.
Prognosis for recovery
Atherosclerosis of the main arteries of the head is a severe pathology of the circulatory system of the brain. Since the disease is asymptomatic, many patients learn about it already at the second or third stage of development, when extensive brain damage occurred.
Statistical data on the prognosis of cerebral atherosclerosis are disappointing: in half of patients in adulthood (up to 55 years), the disease is complicated by ischemic stroke due to severe stenosis of one of the main arteries. Half of the stroke patients either die or remain with severe disabilities.
More than eighty percent of patients with cerebral atherosclerosis have chronic circulatory disorders, and a third of such patients also suffer from a stroke. And only in five percent of patients the atherosclerotic lesion of the main vessels of the brain passes unnoticed, without giving symptoms of the disease and without provoking sharp deterioration.
Diagnosis of atherosclerosis of the main cerebral arteries is possible only after passing a comprehensive examination, which the doctor will prescribe after the initial appointment.During communication with the patient, the specialist carefully collects an anamnesis of the disease and life, details as much as possible all the complaints made by the patient, asks about the presence of factors predisposing to major atherosclerosis.
Then the patient must pass a special blood test - lipid profile. The study allows you to determine the level of cholesterol and its fractions in the blood serum of the patient, as well as their ratio. This will help the doctor assess the state of fat metabolism.
The gold standard in the diagnosis of major atherosclerosis is dopplerographic examination main arteries of the neck and head. Using ultrasound, specialists monitor the quality and speed of blood flow in the vascular bed of the studied areas. This method allows you to identify the exact localization of fat deposits on the inner lining of blood vessels, as well as their density and size.
Angiography is also used to diagnose major atherosclerosis. This is an X-ray examination with the introduction of a special iodine-based contrast agent into the bloodstream. For patients who are allergic to iodine, angiography is contraindicated. With the help of this study, it is possible to identify areas of large cerebral vessels affected by atherosclerosis.
In some cases, doctors prescribe a magnetic resonance imaging. With its help, it is also possible to diagnose the localization and massiveness of atherosclerotic lesions of the main vessels of the brain.
The development of atherosclerosis of the intracranial and extracranial department
Atherosclerosis is a narrowing of the lumen of an artery due to the growth of a plaque in it, consisting of low-density cholesterol, calcium molecules, and the plaque is covered with median fibrous tissue from above.
This vascular pathology leads to a violation of the speed of blood in the main arteries and insufficient supply of organs with blood, which leads to oxygen starvation of organs (hypoxia).
Atherosclerotic neoplasms can grow in the departments of extracranial segments of the arteries of the head, as well as in intracranial arteries (intracranial vessels).
An extracranial level is sclerosis of the thoracic and cervical tracts, which provokes a lack of blood in all parts of the brain. The intracranial level is the hypoxia of one of the parts of the brain where blood from the damaged intracranial vessel does not enter the sclerosis.
As a result of the impaired quality of blood flow in the brain, blood clots accumulate in the basal nodes, as well as in different parts of the cerebral cortex, which leads to thrombosis.
The consequences of thrombosis of cerebral arteries:
- Necrotic foci on brain cells,
- Scarring of brain cells and the development of cysts on it,
- Dystrophy and the death of neurons, which reduce the intellectual ability of a person, and leads him to dementia.
Trunk atherosclerosis of the brain is a rather dangerous pathology that can lead to death.
All the arteries supplying blood to the cerebral arteries originate from the aorta, therefore aortic atherosclerosis can also significantly disrupt the blood supply to the arteries, and the brachiocephalic stem does not receive the necessary amount of blood in the arteries of the brain.
Causes of pathology
The etiology of the development of sclerosis of the main arteries of the brain is quite extensive, and is associated with the age and gender of the patient, his hereditary predisposition.
The most common causes:
- Hypertension with a prolonged and stable increase in blood pressure index,
- The increased cholesterol index and the imbalance between high density lipoproteins, low density lipids, as well as the level of triglycerides in the blood,
- Alcohol dependence in the chronic stage, provoking hypertension and systemic atherosclerosis,
- Nicotine addiction - vessels lose their strength and elasticity under the influence of nicotine, which leads to trauma to the endothelium, on which plaques form,
- Pathology diabetes mellitus,
- Pathology of the heart organ,
- Inactive lifestyle, which contributes to cholesterol growths in the highways, because in case of inactivity, the blood flow speed decreases and blood clots form,
- Lack of culture in nutrition. Excessive consumption of fatty and fried foods, as well as the passion for fast foods,
- Congenital malformations of the aortic branch, as well as branching anomalies of the brachiocephalic trunk and the structure of the carotid arteries.
The brachiocephalic trunk is part of the branching of the aorta, which is a large main artery in the bloodstream.
Branches of the brachiocephalic trunk supply blood to the right side of the humerus of large vessels:
- Right subclavian main artery,
- Right carotid main artery,
- Right-sided vertebral great vessel.
It is very important to pay attention to the development of the brachiocephalic arteries, due to the fact that they are the mainstream of the blood supply to the brain cells.
With the development of atherosclerosis of the main canal, it can develop dementia in the brain and lead to a stroke.
Quite often, a hemorrhage in the brain ends with the death of a sick person.
Two types of atherosclerotic lesions of the brachiocephalic arteries are distinguished.
The type of pathology depends on the size of the lesion of the vessel:
- Non-stenotic type of atherosclerosis BCA,
- Stenosing lesion of BCA.
With severe development of atherosclerosis of non-stenotic sclerosis in the brachiocephalic arteries, the atherosclerotic spot can occupy a large part of the lumen and lead to clogging of the artery.
The stenosing type of BCA atherosclerosis is a severe pathology in which the process of growth inside the lumen proceeds quickly enough, which can lead to a short term occlusion of the trunk and death.
Atherosclerosis of the brachiocephalic arteries of the brain to contents ↑
Systemic atherosclerosis of the internal carotid arteries
Depending on the clinical manifestations in the carotid main vessels, atherosclerosis is divided into:
- Stenosing type of main carotid sclerosis - the lumen of the carotid artery is reduced by more than 50.0%. Only surgical treatment
- Non-stenotic type of main carotid atherosclerosis - the lumen of the artery is reduced by less than 50.0%. Medication for a long period of time,
- Multifocal type of main carotid sclerosis. This pathology is treated depending on the state of functioning of the departments of the brain.
Ischemic strokes or brain infarctions lead to death in 5.0% of patients with atherosclerosis in the carotid main vessels.
The danger of the formation of atherosclerotic neoplasms in the carotid arteries is that platelet molecules adhere to the sclerosis-damaged endothelial layer and form a blood clot that can enter the cerebral vessels along the mainstream and lead to a stroke.
Signs of defeat
Sclerosis develops slowly, due to the large diameter of the great vessels, and the patient feels the first signs then, atherosclerosis cord progresses not only in extracranial vessels, but also in intracranial parts of the brain.
Symptoms of major sclerosis of the head are:
- Soreness in the head, which is quite intense and often manifests itself,
- Severe headache occurs suddenly,
- Strong dizzy,
- General weakness and fatigue of the body,
- Upper limbs go numb, fingers lose sensation,
- Flickering flies in the visual organ, and a decrease in the quality of vision,
- Sleep is disturbed, the patient wakes up sharply at night and cannot sleep,
- Instability and unsteadiness of gait,
- Rapid decline in memory,
- The expressed state of violation in intellectual abilities,
- Dementia develops
- Apathy and depression
- Fainting state
- Decrease in working capacity or its complete loss.
Manifestations of major sclerosis of cerebral vessels during diagnosis allows you to establish the stage of development of pathology.
Stage No. 1:
- The pupils respond slowly to light,
- Asymmetric or pathological reflexes in a patient.
Stage No. 2:
- Very bad memory. The patient becomes limp and loses control over the situation,
- Great decrease in performance
- Intellectual ability is deteriorating
- The psyche is broken
- Microstrokes and their consequences in the form of paralysis.
Stage No. 3:
- Cognitive function is severely impaired,
- Severe damage to neurons.
Treatment of major atherosclerosis must begin with non-pharmacological methods:
- Get rid of addictions - smoking and alcohol,
- Fight Overweight - reduce weight through physical activity and low-calorie nutrition,
- Avoid nervous situations and stress,
- Adjust power - introduce fish into the diet, as well as the maximum number of vegetables, garden greens and fruits. Eat cereal cereals and vegetable oils daily. Exclude fatty meats and fatty dairy products from the diet. The meat should be - chicken and turkey skinless, young low-fat veal. Sour-milk products should be fat-free. Exclude sweets and flour products from the diet,
- Observe the daily routine - a full night's rest reduces the progression of sclerosis,
- You can get rid of physical inactivity by sports training. or physical therapy methods.
Medication for sclerosis of the great vessels of the brain is carried out individually by the attending doctor. Drugs are prescribed on the basis of diagnostic results.
The use of medicines for self-treatment is dangerous, because the drugs have many contraindications and negative effects on the body.
|Group of medications||Name of medications|
|Sequestrants of bile acids||Medication Colesteramin,|
|· Medication Colestipol.|
|Antiplatelet agents||· Medication Aspirin,|
|Vasodilating medications||Trental medication|
|Beta blockers||Carvedilol medication|
|· Metoprolol tablets.|
|Nootropic drugs||· Medication Piracetam,|
|· Medicine Nootropil.|
|Antihypertensive diuretic medicines||Hypothiazide medication|
|· Tool Diacarb.|
|Antispasmodic medicines||Spazmalgon medicine.|
If drug therapy did not help reduce the symptoms of atherosclerotic manifestations and reduce plaque by less than 50.0% of the lumen, then treatment is prescribed with surgery.
Open operations are performed on the main arteries of the brain and a minimally invasive technique is used, which is less traumatic.
Methods of operating the main vessels of the brain:
- Carotid Endarterectomy - open surgery to remove atherosclerotic plaque in extracranial sections of the great vessels,
- Balloon-type angioplasty is performed in an inaccessible place where endarterectomy is not possible.. The operation is performed in extracranial and intracranial departments,
- Minimally invasive stenting method. Through a puncture on the body, a stent is inserted into the main artery, which expands the arterial lumen,
- Prosthetics of a damaged line in an extracranial area. The damaged section of the trunk is replaced with an artificial implant, or on a part of the vein from its own body.
- Establish proper nutrition,
- Active lifestyle and adequate physical activity,
- Refusal of nicotine and alcohol,
- Preventive diagnosis of the body. Laboratory diagnostics can detect an elevated cholesterol index, and instrumental preventive diagnostics will identify the development of sclerosis in the main vessels in the initial stages.
Treatment and prevention of disease
Patients with atherosclerosis of large cerebral arteries should understand that completely cure this disease impossible. But modern medicine has the power to halt its development, thereby increasing the duration and quality of life of patients. To date, there is medical and surgical treatment of major atherosclerosis.
Drug therapy includes the administration of lipid-lowering drugs (Lovastatin, Atorvastatin), antithrombotic drugs (Cardiomagnyl, Losperin), as well as vascular drugs (Latren, Actovegin, Pentoxifylline). A combination of drugs with traditional medicine (infusions, decoctions of medicinal plants) is possible.
Against the background of therapeutic treatment, it will be necessary to carry out lifestyle correction the patient. Doctors say that normalizing nutrition will help stop the development of the disease. Also need daily cardio loads (walking, swimming or cycling), restoring sleep and wakefulness. It is necessary as soon as possible to give up harmful addictions (alcohol, smoking tobacco or hookah, prolonged sitting at the computer). Experts give the same recommendations to prevent the occurrence of major atherosclerosis in patients with a predisposition to it.
In the absence of the proper effect of conservative treatment, patients are invited to solve the problem surgically. The essence of the operation for atherosclerosis of the large cerebral arteries is to restore their patency by installing a special device - a stent or by removing fatty deposits from the inner surface of the vessels.
Atherosclerosis of the main cerebral vessels is a dangerous disease that over time causes disability or premature death of patients. To avoid this, you should adhere to preventive recommendations, regularly examine the state of fat metabolism.
When the first symptoms appear, consult a doctor as soon as possible. This will help to gain time in the fight against the disease!
Treatment of atherosclerosis of the main arteries
Treatment of atherosclerosis of the main arteries is impossible without an integrated approach. It will not be possible to improve the state of health only by adhering to proper nutrition, or, on the contrary, only by taking pills prescribed by a doctor.
Drug treatment is reduced to taking the following funds:
Antiplatelet agents, including cardiomagnyl, plavix, thrombo-ass and others,
Means aimed at reducing blood viscosity. These include phloenzyme, sulodexide and others,
Drugs to improve peripheral circulation - nicotinic acid, alprostan,
Medicines that enhance collateral circulation. These are actovegin and solcoseryl,
Means that can reduce blood cholesterol, among them: torvakard, krestor and others,
Medicines designed to eliminate pain symptoms (analgesics), reduce inflammation (NSAIDs), eliminate concomitant disease (etiological agents).
In addition, patients are shown lifelong administration of acetylsalicylic acid preparations, which can reduce the risk of blood clots. It can be either cardiomagnyl or thrombotic ass. The course intake of vitamins is aimed at maintaining the normal state of tissues and organs that lack blood circulation.
Patients with a diagnosis of atherosclerosis of the great arteries will need to reconsider their lifestyle. This includes giving up bad habits: drinking alcohol and smoking. In the presence of excess weight, its mandatory reduction is necessary. Revision of the diet is another condition in order to avoid the consequences of atherosclerotic lesions. No less important is the medical correction of high blood pressure and regular physical training.
If an atherosclerotic plaque has narrowed the lumen of the artery by more than 50%, then the patient must be referred for consultation to a vascular surgeon who decides on the need for surgical intervention.
Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from the educational and scientific medical center for managing the affairs of the President of the Russian Federation.
Effective remedies and masks for hair loss (home recipes)
How to easily lower cholesterol without medication at home?
Atherosclerosis is a chronic disease of blood vessels in which cholesterol and other fats are deposited on the inner wall of arteries in the form of plaques and plaques, and the walls themselves become denser and lose elasticity. The vessels gradually become hard due to the subsidence of fats and lime on the walls, and lose their elasticity.
Herbal medicine as a treatment method, according to doctors, can be effective in atherosclerosis. Medicinal herbs are often used as adjuvants to enhance the effects of pharmacy drugs, as well as as the main method of treatment of the disease. The opinion of many patients about is considered erroneous.
Atherosclerosis of the lower extremities is a group of pathological processes that affect the main blood vessels of the lower extremities, and are a progressive violation of the blood supply to tissues due to narrowing (stenosis) or blockage (occlusion) of the arteries. The term "obliterating" by.
Atherosclerosis of the aorta of the heart is a chronic disease that affects the elastic type of artery. It is characterized by the formation of one or more foci of lipid deposits, called atheromatous plaques, on the inner lining of the cardiac aorta. As.
Atherosclerosis of the vessels of the brain is a steadily progressing systemic lesion of the vessels located in the corresponding organ. In medicine, you can find other definitions of this disease, for example, cerebral atherosclerosis or atherosclerotic lesions of the cerebral vessels, but the essence remains unchanged.
The opinion that the diet is an unpleasant and even painful occupation, as it forces one to abandon the majority of “tasty” foods for the sake of “healthy ones,” has taken root in the minds of the majority. However, the list of products approved for use in atherosclerosis is quite wide. The main rule of nutrition in the atherosclerotic process.
The disease is associated with a violation of lipid metabolism. Such a failure provokes the accumulation of so-called "bad" cholesterol in the blood. As a result, "cholesterol plaques" are formed. They, laying on the walls of blood vessels, carry the main danger.At the site of plaque formation, the vessel becomes fragile, its.
Many, if not all, at least once in their life have noticed vivid manifestations of unpleasant symptoms characterizing the onset of organic changes in the brain: causeless headaches, ringing and tinnitus, memory problems, photopsies (false sensation of light in the eyes), etc. These the symptoms indicate cerebral ischemia, or, more simply, a violation of cerebral circulation.
Atherosclerosis of the main arteries of the head begins with the accumulation of fat cells on the walls of arteries. Initially, the clusters are small in size and do not bring significant harm to the body. However, if timely measures are not taken, plaques increase in size and quantity, gradually blocking the vascular lumen.
Atherosclerosis of the main arteries is dangerous for human health, because as a result of the development of pathology, air access to the most important human organ, the brain, is limited. In the severe stage of atherosclerosis, the vascular walls are destroyed, aneurysms are formed. The result of atherosclerosis can be thromboembolism - a dangerous pathology, often leading to death.
Atherosclerosis of the main arteries of the brain is usually divided into two types - local and diffuse. Local atherosclerosis develops in one or more parts of the brain, frontal or parietal area. Diffuse atherosclerosis is characterized by total damage to the brain, in which the brain cells are replaced by connective tissue. With diffuse atherosclerosis, a computed tomogram shows the presence of necrotic processes and multiple aneurysms.
According to the severity of development, the following stages of cerebral artery atherosclerosis are distinguished:
- Non-stenotic atherosclerosis. The disease represents the initial stage of atherosclerotic pathology of the main arteries of the brain. At this stage, cholesterol plaques overlap the arteries by no more than half. Non-stenotic atherosclerosis responds well to treatment, since changes in the vessels are still minimal. Conservative treatment is indicated.
- Stenosing atherosclerosis. Pathology of this type refers to the terminal stages of cerebral artery atherosclerosis. The disease is life threatening, since the vessels are more than half blocked, which complicates the blood supply to the brain. Both brain and extracranial sections of the main arteries of the head are affected. A complex treatment is used, including drug therapy, surgical operations. With stenotic atherosclerosis, the patient is likely to have complications and death.
Regardless of the localization of the site of the main artery affected by cholesterol plaques, the causes of the development of atherosclerosis:
- The presence of bad habits. Particularly dangerous in this sense is smoking.
- Impaired absorption of glucose in the blood.
- Unhealthy diet.
- Frequent psychological stress.
- Over time, high blood pressure. We are talking primarily about situations when such a state did not stop in any way.
- High blood cholesterol.
- Diseases of endocrine origin.
- Age-related changes.
Atherosclerosis of extracranial segments of the arteries is characterized by an intense manifestation of symptoms. The symptoms of the disease are affected by the localization of the pathology.
Symptoms of atherosclerosis of the main arteries include:
- Noise in ears.
- Sudden bouts of dizziness.
- Headaches of a constricting nature. The strength of the pain syndrome is determined by the stage of atherosclerosis, the degree of occlusion, the location of the cholesterol plaque.
- Rapid memory impairment. Short-term memory is particularly affected. The patient quickly forgets what has just been said and recent events. Man forgets the simplest words.Long-term memory worsens in the late stage of atherosclerosis of the great arteries.
- Lack of coordination of movement.
- Blurred speech, impaired diction.
- Violations of night sleep. The patient is unable to fall asleep for a long time, often gets up in the middle of the night. During the day, a person feels tired and drowsy.
- The appearance of dark spots in front of the eyes. The patient can see them both in front of open and closed eyes.
- Tremor of hands.
- Violation of behavioral reactions. Patients have depression, tearfulness, a tendency to sudden mood changes, unmotivated anxiety, suspicion, and exactingness. The mental state of the patient is unstable: the person is annoyed or upset for the most insignificant reason.
Atherosclerosis of the brain vessels often spreads further, including to the legs. In this case, the symptoms are supplemented by the following symptoms:
- Pulse reduction in the lower extremities.
- Fatigue during physical exertion. Especially quickly a person gets tired of walking long distances.
- Cold hands. Small ulcers may appear on them.
- In the later stages of the disease, skin lesions can develop into gangrene.
- With damage to the vessels of the legs, lameness occurs.
- Thinning nails.
- Legs fall out hair.
When the first suspicions of atherosclerosis appear, you should immediately consult a doctor. The doctor will conduct diagnostic measures and, if necessary, prescribe treatment.
For the treatment of atherosclerosis, different groups of medicines are used:
- Antiplatelet agents. Medicines of this group are used to avoid platelet adhesion in the blood. This reduces the likelihood of thrombosis. Antiplatelet agents cannot be used in the treatment of atherosclerosis if the patient suffers from liver or kidney failure, peptic ulcer or has suffered a hemorrhagic stroke. It is undesirable to use antiplatelet agents during pregnancy. Group drugs include Thrombo-ass, Cardiomagnyl, Plavix, and others.
- Drugs to reduce blood viscosity. Allow blood to pass through narrowing in vessels more easily. The group of drugs of this type includes Sulodexide, Flogenzim and some others.
- A nicotinic acid. Improves blood circulation in blood vessels.
- Drugs to lower blood cholesterol. Allow effective treatment of non-stenotic atherosclerosis. The most famous drugs of the group are Krestor, Torvakard.
- Drugs to improve collateral circulation. Medicines of this type include Solcoseryl, Actovegin and several others.
- Drugs to eliminate the symptoms of atherosclerosis. Among them, first of all, anti-inflammatory drugs and analgesics.
The course of treatment with medicines usually takes 8 to 12 weeks. Dosages and duration of therapy are set by the attending physician - separately for each patient.
Surgery for atherosclerosis is prescribed for stenotic disease. There are three types of surgery:
- Bypass surgery. The operation consists in creating an additional channel for blood flow near the damaged vessel. As a result, the surgeon achieves normalization of blood circulation.
- Stenting. The operation consists in installing an implant, due to which the correct blood circulation in the artery is restored.
- Balloon angioplasty. During the operation, a special balloon is inserted into the vessel. Next, the pressure in the balloon is increased, expanding the damaged vessel.
Therapeutic exercises are used for non-stenotic atherosclerosis. It is preferable to conduct classes with a specialist. Separate exercises are performed by the patient independently:
- Walking around the room in measured steps. During the exercise, it is important to monitor the level of blood pressure.
- The slopes of the neck. Get up straight.Smooth exhale, tilt your head back, arching the cervical spine as much as possible. Keep your head in this position for 2 - 3 seconds, then return to its original position. Repeat the exercise, but this time tilt your head forward.
- Hands up. Take a standing position, arms on his chest. Raise your hands up, straightening the spine as much as possible. Lower your hands, returning to the original position. Repeat exercise 10 to 12 times.
- Tilts to the sides. Get up straight. Lean alternately to the sides.
- Breeding legs on a chair. Sit on a high back chair. Take your leg to the side and hold it for several seconds in this position. Return to the original position and repeat the exercise with the other leg.
Traditional medicine is not used as an independent treatment, but as an adjuvant. The main task of drugs from the arsenal of folk remedies is to reduce the intensity of the symptoms of atherosclerosis of the main arteries.
The proven remedies include the following recipes:
- In 300 grams of boiling water add a teaspoon of birch buds. The composition is boiled for half an hour. Next, the tool is given 2 hours to infuse. Use tincture three times a day for 100 grams.
- 200 grams of boiling water add a teaspoon of dried flowers of hawthorn. Then boil the liquid for 30 minutes. Filter the broth and let it cool. Take the composition 3-4 times a day.
- To prepare the medicinal composition, you will need the juice of one onion and a tablespoon of honey. The components are combined, a small amount of water for the liquid composition is added. Use the drug three times a day for a teaspoon.
Treatment of atherosclerosis of the main arteries is associated with a strict diet. The main goal of therapeutic nutrition is to prevent the excessive intake of low-density ("bad") cholesterol.
For proper nutrition, the following rules should be observed:
- Include foods that contain a lot of iodine in your diet. An example of such a product is seaweed.
- Completely exclude the use of animal fats. Protein deficiency is recommended to be replaced by legumes. Meat is allowed - chicken and turkey. Fatty meats should be completely omitted from the menu.
- Eat more diuretic products. These include watermelons, melons, apples.
- Include enough vegetables, fruits, berries, and nuts in your diet.
- Completely abandon sweet, strong tea, coffee, chocolate, preservation.
A healthy diet can slow the development of atherosclerosis of the great arteries and reduce the onset of symptoms.
Complications and prognosis of the disease
Of particular danger are the complications of atherosclerosis, which include:
- The inability to perform any mental work due to progressive stenosis.
- Stroke. Due to complete blockage, rupture of the vessel and hemorrhage in the brain occur. Increased blood pressure can lead to a similar result. Hypertensive crisis entails compression of the vessels, which is why the clearance in them is greatly reduced.
- Atrophy of brain tissue. The consequences of this complication are mental disorders and dementia.
- Aneurysms in the arteries of the brain. Extremely dangerous complication, due to which the vascular walls are torn.
The prognosis of atherosclerosis is determined by the stage of pathology, the degree of reduction of the lumen in the vessels, the localization of the process, the number of cholesterol plaques.
The success of the treatment of atherosclerosis of the main arteries is determined by the time of detection of the pathology. The earlier the disease is diagnosed, the higher the chances of success.
Ultrasound of the vessels of the neck (duplex angioscanning of the main arteries of the head)
The cost of duplex scanning of the main vessels of the neck is 200 hryvnia.The price includes the study of vessels of the basin of the carotid and vertebral arteries, venous outflow pathways and functional tests. A detailed report on the study, printing images and recording on electronic media.
Promotion: when examining the vessels of the head and neck (duplex scanning) - echocardiography (ultrasound of the heart) - for free! Saving 250 hryvnia!
The objectives of the ultrasound of the vessels of the neck
Ultrasound of the vessels of the neck is used to diagnose changes in blood vessels . which extend from the aortic arch and carry blood to the brain, muscles of the neck and head, and to the thyroid gland. The ultrasound of the vessels of the neck allows you to diagnose changes in arteries such as the brachiocephalic trunk on the right, common carotid arteries on both sides, vertebral arteries on both sides, external and internal carotid arteries on both sides. With ultrasound of the vessels of the neck, the diameter of the arteries, the state of the walls of the vessels, changes in the lumen due to the presence of blood clots, diseases of the vessel wall, atherosclerotic plaques or compression of the vessels from the outside are evaluated. It is possible to diagnose anomalies in the structure of blood vessels - for example, pathological tortuosity, the absence of a vessel, its narrowing or expansion. The main question that is posed when appointing an ultrasound of the vessels of the neck is the assessment of the ability of the vessels to provide nutrition to the brain. Any process that occurs both inside the vessel and from the outside can lead to narrowing of the lumen of the artery - stenosis or to the complete closure of the lumen of the vessel - occlusion. The task of the ultrasound of the vessel is to assess the degree of stenosis, and with occlusion, to assess the development of the collateral circulatory system. The collateral circulatory system develops by the appearance of bypasses of blood delivery to those areas that were supplied with blood by a clogged artery. The most striking example is atherosclerosis of the subclavian artery, when the blood supply to the arm is through the vertebral artery and movement of the arm can cause a deterioration in the blood supply to the brain. To diagnose this condition, it is necessary to know not only the diameter of the vessels of the neck, but also the direction of blood movement in them. With ultrasound of the vessels of the neck, the characteristics of blood flow are assessed - the speed of blood flow through the vessels, the nature of the blood flow (laminar or turbulent), velocity drops in different parts of the vessel, the elasticity of the vessel wall, the symmetry of all these characteristics on both sides.
Such a study of the vessels of the neck is called duplex angioscanning, since the study is used simultaneously in the two-dimensional mode and in the Doppler mode (color and / or spectral).
Assessment of narrowing of arteries with ultrasound of the vessels of the neck
In 2003, the American Society of Radiologists recommended the use of the following criteria to assess the degree of carotid artery stenosis.
- Norm - peak systolic velocity in the internal carotid artery does not exceed 125 cm / s, while plaques or thickening of the inner layer of the vessel are not visualized
- Stenosis from 50-69% - peak systolic velocity is 125-230 cm / s
- Stenosis more than 70% - peak systolic velocity above 230 cm / s
- Stenosis of more than 90% - with duplex scanning, a significant narrowing of the lumen of the vessel and a decrease in blood flow velocity are recorded
- With complete occlusion (blockage) of the vessel - blood flow is not registered.
- Of auxiliary importance is the determination of the ratio of peak systolic velocity in the internal and common carotid arteries. With stenosis of the internal carotid artery, the ratio increases by more than 3 times. Especially useful is the calculation of this ratio in patients with heart failure and a decrease in the ejection fraction of the heart muscle (left ventricle of the heart). For the same reasons, it is necessary to measure blood pressure on both hands in a patient before the examination.
Prognostic criteria for ultrasound of the vessels of the neck
On modern devices with high resolution for ultrasound of the vessels of the neck, the state of the intima-media complex is assessed. This is the innermost layer of arterial vessels, which first begins to change with atherosclerosis. Changing the thickness and structure of the intima-media complex is a very important prognostic sign for ultrasound of the vessels of the neck. It is believed that the excess thickness of the intima-media complex in the common carotid artery is more than 0.87 mm, and in the internal carotid artery greater than 0.9 mm is a factor that is associated with a high risk of cardiovascular diseases (myocardial infarction and stroke). Figuratively speaking, assessing the thickness of the intimate media complex in the carotid arteries is a window into which you can look into the diagnosis of atherosclerotic lesions of all vessels. The value of the limiting thickness of this complex varies depending on gender, age and race.
What can be detected with ultrasound of the neck vessels
The most common pathology detected with ultrasound of the vessels of the neck - the presence of atherosclerotic plaques in the lumen of blood vessels. Since the symptoms of circulatory disorders, noticeable to the patient, develop only after blocking the lumen of the vessel by more than 60%, the formation of plaques and blood clots may be asymptomatic for a long time. Plaques with ultrasound of the vessels of the neck can be of various shapes and compositions. The task of the researcher is to describe in detail the composition of the plaque and its localization.
Often atherosclerotic plaques disintegrate, blood clots form on them, which can completely block the lumen of the artery or come off, causing clogging of other, smaller vessels. These conditions often end in the development of a stroke (death of a portion of brain tissue) due to acute cerebrovascular accident. Stroke is a disease with a high mortality rate (about 40%), and more than half of stroke survivors become disabled. Recently, strokes develop in people at an increasingly young age (up to 60 years).
Factors contributing to the development of stroke: smoking, diabetes, high blood pressure, overweight, female gender, the presence of a similar disease in blood relatives.
If such factors are present in a person, he needs to undergo a study of the vessels of the neck as early as possible. Also, a study of the vessels of the neck must be done if you are concerned about dizziness, chronic headaches, impaired coordination, memory and speech.
To rare cases that are diagnosed with ultrasound of the vessels of the neck, is the dissection of the wall of the carotid artery - the detachment of its site with subsequent thrombosis.
Mandatory information obtained by ultrasound of the vessels of the neck is a study of the volume of blood that flows through all the vessels of the neck into the brain per unit time. Adequate blood flow to the brain is the main factor that is taken into account when assessing the pathology of cerebral circulation. Normally, in a healthy person, about 15% of the blood that the heart pumps in a minute enters the vessels of the brain. With the help of ultrasound of the vessels of the neck, it is possible to very accurately calculate exactly how much blood enters the brain. For this, the volumetric blood flow velocity is added up in all four vessels supplying the brain, namely, in the internal carotid arteries and in the vertebral arteries on both sides. Correctly conducted research is close in accuracy to the results obtained during positron emission tomography.
Preparation and conduct of the study
Training during the ultrasound of the vessels of the neck is not required. It is only necessary, if possible, to refuse to take medications that affect blood pressure.
During the study, the patient does not experience any inconvenience or pain.The study of the vessels of the neck is carried out in several planes, first in black and white mode, then they switch to duplex scanning and pulsed dopplerometry. At the same time, the shape of the vessel and its geometry are first assessed, linear dimensions and areas in the presence of stenosis are measured. Color Doppler is used primarily for the diagnosis of plaques invisible in black and white. At low blood flow velocities, for example, with almost complete vessel occlusion, an energy doppler is used. Using a pulsed Doppler, linear and volumetric blood flow measurements are taken.
Very often, the ultrasound of the vessels of the neck is carried out as a study preceding the ultrasound of the vessels of the brain. This is due to the fact that, when searching for the causes of cerebrovascular accident, it is more logical at first to make sure that enough blood flows through the main vessels.
Atherosclerotic lesion of the main arteries of the head
INDICATIONS FOR SURGICAL TREATMENT
Among vascular diseases, cerebral stroke occupies one of the leading places both in the frequency of occurrence and severity of the course, and in the disability of the population and mortality.
In Russia, 35 people per 10 thousand people suffer cerebrovascular accident every year, i.e. up to 700 thousand a year, and the leading place among them is ischemic stroke. Currently, more than 1 million people in the country are deeply disabled due to a stroke. In Moscow alone, over the past five years, ischemic disorders of cerebral circulation have increased by 40 percent. Mortality after cerebral stroke remains high and amounts to 30-35 percent. Only 10-20 percent. patients who survive the acute stage of the disease are restored to work capacity, the rest become disabled with a persistent neurological deficit. Now, according to the severity of economic losses, cerebral stroke has firmly taken first place, surpassing even myocardial infarction. The costs of treatment and social security for patients who have had a stroke are huge, in the USA, for example, they amount to $ 7.5 billion a year.
The fact of the development of cerebral ischemic stroke cannot be considered as an indication for surgical intervention. In particular, a stroke that developed as a result of material embolism on the background of endocarditis or diffuse atherosclerosis today does not have real prospects for surgical treatment. The methods of revascularization at the pial-capillary level of the arterial bed have not yet gone beyond the scope of experimental laboratories, and the main burden for the treatment of this category of patients lies with a neurological hospital.
Surgical treatment of stroke, resulting from damage to intracranial main vessels, is often possible by creating bypass shunts - the application of extra-intracranial anastomoses in conditions of neurosurgical and vascular hospitals.
Treatment of cerebral stroke due to the pathology of extracranial main vessels is one of the most important tasks of vascular surgery and neurosurgery.
Of particular note is the problem of surgical treatment of atherosclerotic lesions of the main arteries at the "pre-stroke" stage, when patients undergo only transient ischemic attacks or have a deficiency of blood supply to the brain.
The current stage of solving the problems of diagnosis and treatment of cerebral stroke is characterized by a sufficiently high resolution of the diagnostic complex and surgical equipment. At the same time, the arsenal of medications for influencing the pathogenetic links of stroke did not undergo significant changes. This circumstance has led to a significant increase in the role of surgical methods of treating diseases of cerebral vessels and the main arteries of the head, a consequence or complication of which is cerebral stroke. Surgical interventions of a revascularizing nature occupy a significant, and in some cases leading place in the complex treatment of cerebrovascular disorders and their residual effects, successfully fulfilling the task of restoring impaired cerebral function and optimizing cerebral blood flow indices.
Multicenter studies of the results of complex treatment of cerebral stroke in Europe (European Trial of Carotid Surgery - ECST), in North America with the participation of several European centers (North American Simptomatic Carotid Endarterectomy Trial -NASCET) were carried out. In addition, a third study (Asymptomatic Carotid Atherosclerosis Study - ACAS) was performed in individuals with carotid arteriosclerosis without concomitant brain symptoms in North American centers. These studies, each of which included at least 1,500 cases, made it possible to formulate indications for surgical correction of the main arteries of the head. Based on randomized trials, two treatment methods were compared: carotid endarterectomy in combination with drug prevention of stroke and drug treatment only. The undoubted advantage of carotid endarterectomy was proved, especially with an increase in the degree of stenosis in patients with clinical manifestations of dyscirculation in the pool of the internal carotid artery, all other things being equal. In the asymptomatic course of the disease, surgical prophylaxis gives a slight, but statistically significant decrease in the frequency of stroke in people with a narrowing of the diameter of the internal carotid artery by more than 60 percent.
Treatment and clinical observation of patients with cerebrovascular pathology due to lesions of the main arteries of the head should be carried out under the supervision of neurologists - neurosurgeons and vascular surgeons.
The diagnostic algorithm includes physical and neurological examination, ultrasound Dopplerography of the main intracranial and intracranial vessels, duplex scanning, computed tomography of the brain or magnetic resonance imaging of the brain, cerebral selective angiography, the study of central hemodynamics, respiratory function, kidney, biochemical and clinical laboratory research.
The volume of diagnostic studies at the outpatient stage can be reduced for patients with repeated transient attacks and acute thrombosis of the retinal arteries in the presence of dopplerographic hemodynamically significant stenosis of the main arteries of the head (MAG) supplying this pool, until the cardiologist estimates the tolerability of the operation.
In cases of acute or progressive cerebrovascular pathology, the integrative scheme should be significantly reduced, and such patients are sent from the clinic to a specialized department on an emergency basis.
Patients with clinical manifestations of cerebrovascular insufficiency according to the results of the examination should be assigned to the group of conservative or surgical treatment.
Surgical treatment is performed for patients with various variants of lesions of the carotid and vertebral-basilar pools. Absolute and relative indications and contraindications to surgical methods of treatment are determined.
Absolute indications for carotid endarterectomy (CEAE):
- carotid stenosis with a clinic of transient ischemic attacks or manifestations of decompensation of discirculatory encephalopathy (in patients with severe, more than 70 percent. Ipsilateral stenosis, leading to impaired cerebral circulation and cerebral infarction).
- the presence of a heterogeneous plaque in the mouth of the internal carotid artery of the ICA, even with asymptomatic stenosis.
Risk factors for cerebral stroke, such as age, arterial hypertension, elevated blood lipids, smoking, and diabetes, should also be considered in this group.
Relative indications for CEEA:
- asymptomatic stenosis (up to 70 percent) of the carotid arteries,
- asymptomatic stenosis of the carotid arteries with dopplerographic signs of stenosis of more than 90 percent,
stenosis of the carotid arteries from 30 to 69 percent. with neurological manifestations,
rapidly progressing carotid stenosis (patients with asymptomatic stenosis six months ago),
gross carotid stenosis with ipsilateral neurological symptoms and contralateral carotid artery thrombosis,
gross carotid stenosis with a single symptom - fugax ipsilateral amovrosis,
gross carotid stenosis complicated by a stroke with manifestations of hemiparesis or aphasia (not earlier than a month after a stroke),
gross carotid stenosis with a completed stroke in the pool of the affected artery,
gross carotid stenosis with ipsilateral symptoms and cardiac embologous cause of stroke (confirmed by echocardiography or atrial fibrillation),
gross carotid stenosis, asymptomatically proceeding before the operation of coronary artery bypass grafting.
Contraindications to carotid endarterectomy:
- carotid stenosis of less than 30 percent. with ipsilateral neurological deficit,
- carotid artery thrombosis with ipsilateral neurological symptoms,
- non-hemispheric symptoms, such as headache, fatigue, syncope, etc. with verified gross carotid stenosis,
- transient ischemic attacks in the vertebro-basilar basin,
- gross carotid stenosis with symptoms of damage to the opposite hemisphere of the brain,
- gross carotid stenosis with ipsilateral severe stroke with hemiplegia and / or coma,
Rough carotid stenosis with ipsilateral symptoms and severe concomitant pathology (cancer metastases, organic damage to the central nervous system, etc.).
There are several types of carotid endarterectomies - open, eversion, various options for arterial prosthetics using veins and prostheses (homo and heterotransplants). The choice of the method of operation depends on the degree of damage to the carotid pool, its length. The most optimal are direct and eversion endarterectomies - with the latter, the operation time is significantly reduced, and the geometric parameters of the reconstructed vessel are minimally changed.
For adequate brain protection during carotid endarterectomy, careful selection of patients, rapid surgical technique, general anesthesia, systemic heparinization, and Dopplerographic monitoring in the pre- and intraoperative period are necessary. In some cases, it is necessary to use a temporary intraluminal shunt, the indications for use of which are as follows:
1) contralateral occlusion of the internal carotid artery,
2) severe stenosis or occlusion of the vertebral or main artery with an inferior willis circle (absence of PSoA or A1 segment).
3) low tolerance of the brain to ischemia, even against the background of preventive superimposed extra-intracranial microanastomosis.
Indications for vertebral artery reconstruction:
Symptoms of unstable hemodynamics in the vertebral-basilar pool:
- stenosis of the dominant vertebral artery of more than 75 percent.,
- stenosing process with the same degree of stenosis of both vertebral arteries,
- segmental occlusion of the second segment of the vertebral artery in the presence of another hypoplasia.
2. Clinic of stem discirculation of thrombembolic origin in identifying the source of embolism from the vertebral artery.
3. Stenosis of the carotid pool, subject to reconstruction in the presence of pathology in the vertebral-basilar pool, listed in paragraph 1.
4. Extravasal compression significantly affecting vertebral blood flow (cervical rib, Kimmerle abnormality, uncovertral and other spondylogenic causes).
Surgical reconstruction of the pathology of the first segment of the vertebral artery consists in a standard endarterectomy of the mouth of the artery through supraclavicular access, and if it is impossible to perform (with extended damage to the vertebral and / or subclavian arteries), it is necessary to use the methods of moving the artery - vertebral carotid anastomosis (bypass), etc. .
Indications for surgical treatment of subclavian artery lesions:
1. The presence of phenomena of intracerebral "robbery", consisting of signs of ischemia in the vertebral-basilar pool and / or upper limb.Signs of a combined lesion of the carotid and vertebral-basilar arteries at the same time.
The most common mechanism for the formation of these symptoms is any serious restriction of blood flow due to critical stenosis or embolism of the main arterial vessel as a result of ulceration of the atheromatous plaque.
2. Heterogeneous atherosclerotic plaques in the first segment of the subclavian artery in the absence of manifestations of intracranial arterial pathology, clinically manifested by vertebral-basilar discirculation.
3. Hemodynamically significant (75 percent or more) stenosis of the first segment of the subclavian artery.
4. Asymptomatic lesions of the first segment of the subclavian artery (> 75% of its diameter) in patients who are shown to have a mammary-coronary anastomosis in order to prevent the development of coronary-mammary-subclavian "robbery" syndrome.
5. Subclavian artery revascularization is also indicated for patients who have undergone a mammary-coronary anastomosis, and the progression of coronary heart disease is associated with the phenomenon of coronary-mammary-subclavian "robbery".
6. Bilateral asymptomatic occlusion of the subclavian artery in order to create adequate main blood flow in patients who are shown systemic hemodialysis or performing subclavian (axial) -femoral bypass surgery.
The choice between sternal and supraclavicular access depends on the location of the damaged segments of the trunk. With asthenic physique and moderate patient nutrition, it is preferable to impose a carotid-subclavian anastomosis. In people with normosthenic or hypersthenic physique against the background of increased nutrition, it is preferable to use carotid-subclavian prosthetics.
Indications for the application of extra-intracranial anastomosis:
- ICA thrombosis with depletion of reserves of collateral circulation,
- hemodynamically significant stenosis of intracranial segments in the basins of the middle, anterior or posterior cerebral arteries,
- as the first stage before carotid endarterectomy on the ipsilateral side in the absence of adequate collateral blood flow along the vilizium circle,
- with tandem lesions of the internal carotid artery with a low degree of tolerance of the brain to ischemia, when multi-stage surgical treatment is indicated,
- with bicarotid stenosis with a tandem lesion of one of the carotids: first, the first stage is the restoration of adequate patency of the carotid artery, contralateral tandem lesion, then the phased application of EIKMA.
X-ray endovascular angioplasty should be performed only with adequate technical equipment. Endovascular angioplasty for local stenosis is preferred.
A rigorous assessment of indications and contraindications for surgical treatment, detailing of the stages of the operation, the presence of a technically highly equipped specialized surgical team, intraoperative monitoring of cerebral hemodynamics, adequate resuscitation aids are the main factors that minimize the risk of postoperative complications and adequately restore cerebral perfusion.
In conclusion, it should be noted that the treatment of acute and chronic cerebrovascular pathology, of course, should be carried out by generally accepted methods. There is no doubt the priority value of traditional therapy in the treatment of this category of patients.
Experience shows that there is a strictly defined category of patients with pathology of the vascular system of the main arteries of the head, which undoubtedly is at risk of developing cerebral vascular catastrophe or already suffers from cerebral discirculatory disorders, the optimal treatment of which can only be achieved by surgery.International cooperative studies have confirmed the undoubted advantage of surgical treatment of stenotic lesions of the main arteries of the head to prevent the development of stroke or its progression.
The correct clinical approach to this group of patients may be decisive in preventing the development of the disease, maintaining the quality of life, and indeed life itself, if the question of the diagnosis and indications for surgical treatment is timely resolved. The choice of indications for surgery, the most appropriate surgical correction method, and the prevention of postoperative complications largely depends on the possibilities of a detailed study of the pathological process, its verification, strict assessment of contraindications to it, and on the availability of a highly equipped specialized surgical team and an adequate resuscitation aid.
Georgy MITROSHIN, Head of the Center
A.A. Vishnevsky, Honored Doctor of the Russian Federation.
Valery LAZAREV, Leading Researcher
vascular department of the Research Institute of Neurosurgery
them. NN Burdenko RAMS, doctor of medical sciences.
Gennady ANTONOV, Head of Department
Angioneurosurgery TsVKG named after A.A. Vishnevsky,
Atherosclerosis magician is a pathological condition in which cholesterol plaques are deposited on the walls of the main arteries of the head, blood supply and oxygen supply to the brain are disturbed. The disease affects men after the age of 45, women - 55 years.
Lifestyle, poor nutrition affect your health. The intake of a large amount of fat, the deposition of lipid plaques in the body are the main reasons that lead to stenosis of the brain, coronary arteries, blood vessels of the brain, lower limbs and neck. Arteriosclerosis is asymptomatic for a long time. When the internal forces are exhausted, typical symptoms of MAG appear:
- Sudden onset of dizziness, constricting headache. The intensity of the pain syndrome depends on the duration of the process, level, degree of occlusion, localization of the plaque.
- Patients suffer from tinnitus, dizziness.
- Memory is progressively decreasing. A characteristic sign of the disease is a violation of short-term memory: words are forgotten during a conversation, recent events. Long-term memory does not at first suffer.
- Behavioral reactions change: there is a depressive mood, tearfulness, unmotivated anxiety. Patients become suspicious, demanding, irritable, quickly upset.
- Disturbed night sleep. Patients cannot sleep for a long time, wake up in the middle of the night. Throughout the day they feel constant fatigue, drowsiness.
- There is a change in gait, shakiness.
- Speech becomes unclear, fuzzy. Patients forget the names of words.
- Patients complain of dark spots that occur in front of open, closed eyes.
- A hand shake appears.
At the last stages, atherosclerosis of the main arteries of the brain leads to impaired mental activity. A person is not oriented in his own personality, place of stay. The stage of decompensation requires outside care for the patient. He can no longer perform elementary actions.
Arteriosclerosis is divided into stenotic and non-stenotic.
Non-stenotic atherosclerosis is the initial stage of atherosclerotic lesions of the main arteries of the head. Such a diagnosis is almost never found because changes in the intima of the vessel are minimal, the vessel is still non-stenotic. Cholesterol plaque closes the lumen by less than 50%. The prognosis is favorable, a positive effect is observed from conservative therapy.
Stenosing is common, represents the terminal stage of the disease. The clearance of the main arteries of the head is closed by 50% or more.Intensive drug treatment, surgery is required. Stenosing atherosclerosis of the main arteries of the head often causes complications, death. The defeat of the brain and extracranial divisions of the magician is noted.
Cholesterol plaques affect various pools of the circulatory system. When the bloodstream of a large vessel is blocked, the blood supply to all internal organs is disrupted.
Depending on the localization, lesions of the main arteries are distinguished intracranial and extracranial (extracranial):
- Atherosclerosis of the brain. The disease appears during the deposition of lipid complexes on the inner walls of the cerebral arteries. The patient feels a constant, severe headache, dizziness, memory loss, poor sleep, apathy, and is in a depressed mood. Pathology is divided into local and diffuse. The first occurs in the pathology of one or more segments of the brain, frontal and parietal region. Diffuse atherosclerotic lesion - a life-threatening condition that continuously leads to disability. With this pathology, brain cells are replaced by connective tissue. A CT scan reveals necrotic foci, vascular aneurysms.
- Atherosclerosis of extracranial segments of the great arteries is characterized by similar symptoms that develop faster than with other forms of the disease.
- Intracranial - manifests itself in periods of transient disturbance of the blood supply to the brain. In medicine, a pathological condition is called transient ischemic attack. Symptoms are similar to a stroke, but disappear within a day. In such cases, a doctor’s consultation is required.
- Atherosclerosis of the carotid arteries appears with simultaneous damage to paired large vessels of the head. The clinic is similar to other forms. When several large vessels are involved in the pathological process, the risk of ischemic stroke and death is increased.
- Atherosclerotic lesion of the brachiocephalic arteries is accompanied by a violation of the blood supply to brain cells, neck.
- Cholesterol is deposited on the vessels of the heart. Coronary leads to coronary heart disease, heart attack, cardiosclerosis, various forms of angina pectoris, cardiac arrhythmias (arrhythmias, blockades). Complete blockage threatens heart failure. Against the background of coronary sclerosis, arterial hypertension occurs, which often causes strokes.
- The abdominal aorta suffers from the deposition of cholesterol plaques. The disease is manifested by pain in the epigastric region, a feeling of fullness, belching, nausea. It is difficult to distinguish from other diseases of the gastrointestinal tract, requires instrumental diagnosis
- The deposition of lipid complexes occurs in the renal vessels. Signs of the disease will be high blood pressure, dizziness, changes in urine tests.
- Atherosclerosis affects the lower extremities. Patients feel pain, fatigue when moving, swelling, cold feet. A weak pulse is determined on the affected limb. Atherosclerosis of the vessels of the legs is a common cause of thrombosis, embolism.
Screening methods for atherosclerosis include:
- collection of medical history. Find out the causes, concomitant diseases, bad habits, timing,
- measurement of blood pressure, pulse, respiration rate,
- general clinical tests (blood, urine, glucose tests),
- biochemical blood tests (lipid spectrum, renal, liver complex) shows the level of cholesterol, its fractions, helps to identify concomitant diseases,
- ultrasound examines the condition of the carotid and vertebral arteries. The doctor determines the diameter of the vessels, the degree of narrowing,
- magnetic resonance imaging and computed tomography are among the most accurate research methods.They help to know the structure of the arterial vessels of the head, neck, limbs. On the obtained images, images in all projections are visible, which allows to identify the localization and prevalence of pathology,
- angiography allows you to study the blood supply in the vascular system.
After the necessary diagnostic tests, the doctor determines the treatment tactics. When conservative therapy prescribes drugs for the disease (statins, anticoagulants). If the case requires surgical intervention, he advises the patient about the upcoming operation.
Possible complications and life prognosis
Circulatory disorders are dangerous to health. The brain does not receive the necessary amount of oxygen with blood, oxygen starvation occurs, and ischemic areas occur. Complications of the disease have the following manifestations:
- Stenosis threatens the impossibility of performing mental activity.
- Stroke. Complete blockage causes hemorrhage. A similar situation occurs with high blood pressure. Against the background of a hypertensive crisis, the vessels stenose (contract), the arterial lumen sharply decreases.
- Atrophy of brain tissue leads to mental disorders, dementia.
- Often there are aneurysms of the cerebral arteries, which leads to rupture of the walls of blood vessels.
The prognosis of the disease depends on the stage of atherosclerosis, the degree of narrowing, localization, and quantitative lesion. In the initial stages, with timely treatment, the progression of the disease can be prevented. It is important to follow the doctor’s recommendations, change the lifestyle, follow diet therapy. Later stages, the presence of gross cognitive impairment leads to disability of the patient.
With atherosclerosis, the main arteries are first included in the pathological process. Atherosclerosis of the main vessels of the head threatens with a stroke, dementia.
Atherosclerosis mage (short for "main arteries of the head") is a disease that results in impaired blood supply to the brain. This occurs due to the occurrence of cholesterol plaques on the walls of the main arteries.
Cholesterol formations narrow the vascular lumen, because of which the brain does not receive enough oxygen through the blood. Most atherosclerosis affects men older than 45 years and women after the onset of 55 years of age.
Features of atherosclerosis of the great vessels
The development of atherosclerosis is associated with the deposition of fat cells on the walls of arteries. At the beginning, clusters are small and do not cause serious harm. If measures are not taken in time, the plaques grow significantly and block the lumen of the vessels. As a result, blood circulation worsens.
Atherosclerosis of the main arteries of the head is a serious danger to humans. As the disease progresses, blockages in the vessels of the neck and head occur, which are responsible for the full blood supply to the brain.
A severe form of the disease can be accompanied by the destruction of the vessel wall and the formation of aneurysm. Thromboembolism can aggravate the situation. The rupture of such an aneurysm is fraught with serious health consequences until death.
Depending on the severity of the disease, two main varieties are distinguished:
- Non-stenotic atherosclerosis. This term refers to a condition in which a plaque covers no more than 50% of the lumen of the vessel. This form is considered the least dangerous to human life and health.
- Stenosing atherosclerosis. With this course of the disease, the vessel is blocked by a plaque more than half. This greatly affects the blood supply to the internal organs.
The sooner the disease is diagnosed, the greater the chance of success of treatment.It is almost impossible to completely get rid of the disease, therefore, each person needs to take measures to exclude factors that provoke atherosclerosis.
What factors cause the onset of the disease?
In order for the treatment of atherosclerosis of the MAG to be successful, it is necessary to identify and eliminate the cause of its appearance. Among them are:
- High blood pressure.
- Excessive concentration of cholesterol in the blood.
- Diseases of the endocrine system.
- Excessive drinking and smoking.
- Problems with glucose uptake.
- Lack of physical activity.
- Adherence to malnutrition.
- Age-related changes in the body.
- Long stay in stressful situations.
Most often, the disease affects older men. It is especially important for them to monitor the state of their health, adhere to the correct principles of proper nutrition and lifestyle.
Each person periodically needs to control the level of blood pressure and cholesterol in the blood. A timely medical examination will help in this.
Symptoms of atherosclerosis
Atherosclerosis of extracranial arteries is manifested by vivid symptoms. It will largely depend on the location of the plaques. If the lesion falls on the vessels of the brain, then the following symptoms appear:
- The appearance of tinnitus.
- Intense headaches and dizziness.
- Memory problems.
- Uncoordination of movements, impaired speech. Other neurological abnormalities may occur.
- Trouble sleeping. A person falls asleep for a long time, often wakes up in the middle of the night, during the day he is tormented by drowsiness.
- Change in the psyche. There is increased irritability, anxiety of a person, he becomes tearful and suspicious.
Atherosclerotic lesions can be localized in the arteries of the limbs. In this case, the symptoms will be different. The following signs of the disease appear:
- Lower ripple in the lower extremities.
- Quick fatigue during physical exertion. This is especially pronounced when walking long distances.
- Hands become cold. Small ulcers may appear on them.
- In severe cases, gangrene develops.
- If the vessels of the lower extremities are affected, then the person begins to limp.
- The nail plates are thinning.
- On the lower extremities, hair loss is observed.
Symptoms of atherosclerosis MAG may have a different degree of severity. At the initial stage, it is possible to identify the problem only during a medical examination.
If you find the first signs of the disease, you should immediately consult a doctor. Only under the condition of timely diagnosis will it be possible to stop the development of the disease.
It is possible to detect damage to the main arteries of the head only during a full medical examination. Specialists need to determine the localization of the problem, the parameters of the formed plaque, as well as the presence of proliferation of connective tissue.
The following diagnostic methods apply:
- General and biochemical blood tests.
- Ultrasound procedure. An examination of the vascular system, which is responsible for the blood supply to the brain. Carotid and vertebral arteries are examined. The specialist determines their condition, diameter, change in clearance.
- Magnetic resonance imaging. This is an examination that allows you to study in detail the structure of the arteries of the brain, neck, limbs. Modern equipment guarantees obtaining images in various projections. This technique is considered the most informative.
- Angiography. Allows you to study all the pathologies of the vascular system. A specialized contrast medium is injected into the patient's blood. After this, an X-ray examination is carried out.
A specific examination method is selected by the doctor individually for each patient. This takes into account the characteristics of the body, as well as the equipment that a medical institution has.
How is the therapy carried out?
Non-stenotic atherosclerosis in the early stages is treatable. With an integrated approach and accurate adherence to all the prescriptions of a specialist, it is possible to restrain the development of the disease.
Today, the following methods are most effective:
- Drug treatment. It involves taking specialized medications.
- Surgical intervention. This procedure carries a risk to the life and health of the patient. Apply it only in severe cases, when all other methods of treatment are ineffective. Surgical non-stenotic atherosclerosis is not practical to treat.
- Lifestyle adjustment. To stop the development of the disease, it is necessary to abandon bad habits, especially smoking. You should minimize the use of fatty, fried, smoked foods. You need to move more, do sports, enroll in the pool. In this case, the load should be moderate. It is best to consult with a specialist.
- Dietary nutrition. Experts recommend adhering to special nutritional rules. This will help lower cholesterol.
- Exercise therapy. There is a specialized set of exercises that helps restore normal blood supply to all segments of the brain and limbs.
- Health monitoring. It is necessary to regularly measure blood pressure, monitor the concentration of cholesterol in the blood. All concomitant diseases should be treated in a timely manner.
Successful treatment is possible only if all negative factors are eliminated. The patient should avoid stressful situations, eat right and walk more in the fresh air. At the same time, strict adherence to all doctor's recommendations is mandatory.
What medications are used for therapy
Today, several groups of drugs have been developed that give a positive effect in the treatment of atherosclerosis of the main vessels of the brain:
- Antiplatelet agents. Drugs of this type prevent the adhesion of blood platelets, which reduces the risk of thrombosis. Such drugs are prohibited for use in renal and liver failure, pregnancy, peptic ulcer and hemorrhagic stroke. The most popular drugs of this group are Thrombo-ass, Cardiomagnyl, Plavix and so on.
- Blood viscosity lowering agents. They help blood to better pass through narrowed places. These include sulodexide. Flogenzim and others.
- Drugs based on nicotinic acid. They are designed to improve blood circulation.
- Medicines that lower the concentration of cholesterol in the blood. With their help, non-stenotic atherosclerosis can be effectively treated. Among them are Krestor, Torvakard and others.
- Means for enhancing collateral circulation. This group includes Solcoseryl, Actovegin and some others.
- Preparations for the elimination of symptoms. It can be anti-inflammatory and analgesics.
Drug therapy will take at least two to three months. The specific dosage and duration of therapy is determined by a specialist for each patient.
Patients suffering from are shown lifelong administration of acetylsalicylic acid. These drugs will help minimize the risk of thrombosis.
In severe cases, cerebral atherosclerosis is treated with surgery. This technique is used for stenotic type of disease. There are three main methods of operation:
- Bypass surgery. During this operation, the surgeon creates an additional blood flow path near the damaged area.Thus, it is possible to restore normal blood flow.
- Stenting. This operation involves the installation of a special implant, with which it is possible to restore normal blood flow.
- Balloon angioplasty. The procedure involves the introduction of a specialized spray can into the vessel. Pressure is applied to it, which expands the affected vessel.
A specific technique is chosen by a specialist, based on the patient’s health status, as well as in which of the segments of the vascular system the lesion is localized.
Folk treatment methods
You can supplement the main program of therapy with the help of traditional medicine. They can not act as the only way of therapy.
Among the most effective recipes against atherosclerosis are:
- Dilute a teaspoon of birch buds in a glass of boiling water. Boil the resulting composition for 25 minutes. After that, leave the product for a couple of hours to insist. Take the prepared composition three times a day in the amount of 100 ml.
- Pour a teaspoon of dried hawthorn flowers with a glass of water. Such a composition must be boiled for about 25 minutes. After that, it can be filtered. Wait for the broth to cool. It is taken in half a glass three times a day.
- Squeeze the juice from one onion. Combine it with natural honey. One spoonful of juice requires one spoonful of honey. Add a little water to make it liquid. It is necessary to take such a remedy one spoon three times a day.
Such simple remedies will help enhance the effectiveness of traditional treatments. Sometimes they can provoke allergic reactions, so before using them, you must consult your doctor.
During treatment, patients with atherosclerosis are shown to comply with a special diet. This is the only way to reduce the flow of cholesterol into the blood. The following recommendations should be followed:
- Iodine-rich foods, such as seaweed, are recommended.
- A complete rejection of animal fats is shown. Protein deficiency can be made up for legumes.
- Eat more diuretic foods. These include watermelons, apples, melons and others.
- The diet should include more vegetables, fruits, nuts, berries.
- It is allowed to eat chicken and turkey. Fatty meats and offal are strictly prohibited.
- You will have to refuse sweets, coffee, strong tea, chocolate, and canned foods.
Compliance with the principles of proper nutrition will help to stop the development of the disease and strengthen the effect of medications. At the first manifestations of atherosclerosis, you must immediately seek help from a specialist. The sooner a problem is identified, the greater the likelihood of maintaining health.
According to recent sad statistics, more and more people are diagnosed with atherosclerosis. If earlier this disease was considered age-related, now it is rapidly becoming younger. Its most dangerous variety is stenotic atherosclerosis of the MAG (main arteries of the head). The problem is related to the deposition of cholesterol plaques in the blood vessels of the brain, neck and large arteries of the lower extremities. The disease is chronic and it is impossible to completely get rid of it. But you can take measures to stop its rapid development. To do this, you need to remember the peculiarity of the course of the disease and the main therapeutic methods.
Briefly about stenotic atherosclerosis
Atherosclerosis is a chronic disease characterized by damage to the arteries with the formation of cholesterol plaques in them. At the moment, doctors believe that its cause is a metabolic disorder, mainly proteins and lipids.Excess cholesterol, which remains in the body due to improper functioning of lipoproteins, settles on the arteries, forming plaques.
These plaques slightly narrow the lumen of the artery and do not make themselves felt at an early stage of the disease. But if the level of cholesterol in the blood does not decrease, then they grow, grow into the wall of the vessel and provoke the appearance of connective tissue (this process is called sclerosis). As a result, the inner wall of the artery becomes denser, a barrier grows in the way of the blood, and the tissues to which the vessel leads do not receive the required amount of oxygen.
At the beginning of the development of atherosclerosis, the plaques are so small that they hardly affect the blood flow, and the diagnosis sounds like “non-stenotic atherosclerosis”. When the lumen is seriously narrowed, "stenosis" appears and the prefix "non-" disappears. A narrowing of the effective diameter of the artery by 50% is conventionally considered stenosing atherosclerosis.
It is worth noting an interesting fact: the diagnosis of “non-stenotic atherosclerosis” in the world classification of diseases (ICD-10) does not exist. This is due to the fact that doctors do not fully agree with the methods of its classification and diagnosis.
Causes of Stenosing Atherosclerosis
Risk factors for this disease are for the most part lifestyle. That is why this disease is so widespread throughout the world. If we discard some rare and narrowly targeted reasons, the main list looks like this:
- Smoking. According to the European Cardiological Community, nicotine addiction is the main reason for the development of atherosclerosis.
- Obesity. This also includes a sedentary lifestyle.
- Elevated cholesterol, excess lipids.
- Hypertension If the pressure is higher than 140/90, then there is reason to think.
- Stress. This factor has a negative effect on the whole organism, primarily on the cardiovascular and nervous systems.
- Improper nutrition. Especially dangerous is the increased content of fat and cholesterol in the diet.
At least one of the items listed can be found in almost any person. For this reason, stenotic atherosclerosis takes first place due to death in patients with heart disease and is 8 cases per 1000 people.
Manifestations of stenosing atherosclerosis of the coronary arteries are associated with coronary heart disease (coronary heart disease) and heart failure, since the myocardium does not receive the right amount of oxygen. As a result, the central heart muscle, chambers, and valves are degrading. Patients complain of:
- Attacks of angina pectoris. At first, pain behind the sternum appears only during physical exertion, subsequently, half-hour attacks can occur at rest.
- Myocardial infarction.
A heart attack is the last and most dangerous consequence of coronary atherosclerosis. The artery is completely blocked, the myocardium undergoes necrosis. The development of complications is practically guaranteed: aneurysm, shock, rupture and sudden death. If myocardial infarction occurred, then the coronary arteries of the heart were badly affected by the disease.
Atherosclerosis of the renal arteries gives itself off as the only symptom - a constant, non-stopping increase in blood pressure. In the case of blocking one kidney, the disease proceeds smoothly, with symmetrical blocking, a malignant course of the disease is possible.
Stenosing atherosclerosis of the arteries of the lower extremities becomes the cause of disability: lameness, constant pain, amputation. The disease begins with minor manifestations, such as tingling in some areas, a feeling of cold, numbness. If you do not take measures to improve, minor symptoms develop in lameness, muscle weakness, pronounced freezing of the limbs, severe pain. In the last stage, convulsions, tissue necrosis and trophic ulcers appear.
Most often, atherosclerotic plaques occur in the main artery of the body. From it, detached pieces of a blood clot can fall into any part of the body, block the passage and cause a heart attack. In addition, the germination of plaques leads to thickening of the walls of the aorta, aortic dissection and further rupture, which leads to momentary death.
Often the intestines suffer from atherosclerotic changes in the aorta. Patients complain of sudden sharp pain in the stomach, pains of an unclear nature in the intestines. In such cases, urgent hospitalization is needed, since tissue rupture inside the peritoneum is possible.
Stenosing atherosclerosis of the carotid arteries leads to impaired thinking and facial expressions. First, there is a headache and fatigue, followed by impaired memory. In severe cases, speech clarity suffers, vision, facial muscles stop contracting symmetrically.
The most noticeable disorders in the functioning of the brain (brain and spinal cord) and related departments. Stenosing cerebral atherosclerosis damages different parts of the cerebral cortex, which changes the thinking, personality and behavior of a person. With the localization of necrotic processes in the areas responsible for speech, vision and hearing, the patient receives severe damage to these functions until complete failure.
With atherosclerosis of the extracranial divisions of the brachiocephalic arteries, severe neck pain and nausea appear, especially when turning the head.
If stenosing atherosclerosis of the BCA affects the spinal cord, the patient experiences pain in the back and sternum, itching and indications in the limbs, nausea. The pressure is lowered, vision, hearing and speech are impaired.
The consequences of atherosclerosis
In the absence of adequate treatment, the final stage of stenosis of any artery is the infarction of the organ to which it leads. This means that oxygen ceases to enter the organ, and it quickly dies with the formation of necrotic (dead) tissue.
For the heart, this means myocardial infarction, for the brain, stroke, for the kidneys, kidney infarction, and so on. Heart attacks are dangerous not only because the organ stops working, but also because the dead tissue decomposes, releasing toxins into the body. Often these manifestations of pathology lead to death.
To avoid a sad ending, you need to recognize an imminent threat in time and consult a doctor for diagnosis and treatment.
In medicine, all types of treatment are divided into traditional (tablets) and surgical (surgery). In our case, the traditional treatment is also divided into medication and wellness. In turn, with stenotic atherosclerosis, drug treatment is divided into symptomatic and directly therapeutic. In order not to get confused in this hierarchy, we start from the bottom.
Symptomatic treatment is aimed at eliminating the symptoms caused by atherosclerosis. This can be aspirin to thin the blood, painkillers to relieve pain, a wide list of drugs to bring the brain in order.
Medications hold back the disease itself. Some pills can lower blood cholesterol, some lower blood pressure to reduce the burden on the blood system.
Together with therapeutic and symptomatic drugs, the patient is prescribed exercise therapy and wellness procedures. Since the disease is most often provoked by an improper lifestyle, the patient needs to give up smoking, walk more, exercise, be less nervous, sleep well and eat right. The same list is included in the treatment of atherosclerosis.
In total, pills and a healthy lifestyle should stop the development of atherosclerosis and slowly repair damaged arteries. But sometimes the disease goes so far that traditional treatment is no longer enough. In this case, the specialist can prescribe a surgical intervention - bypass surgery, angioplasty, stenting or surgery to remove.When bypassing, an artificial vessel is established to bypass the affected artery, angioplasty expands the lumen of the vessel, stenting slows the development of the plaque using a special scaffold, and when removed, the damaged vessel is completely removed.
In general, surgeon assistance is relatively infrequent. If the patient turned to the doctor on time and did not harm himself with self-medication, it can usually be treated with traditional methods.
So, stenotic atherosclerosis is a systemic chronic disease that asymptomatically develops for a long time and makes itself felt after about 40 years. It manifests itself in the form of plaques in the arteries and impairs blood flow until it is completely blocked. Being untreated, it leads to severe disorders in the body, disability and death. If you suspect this disease, do not self-medicate so as not to miss the time - you need to see a doctor as soon as possible and start the examination.
Who runs the risk of getting atherosclerosis early?
Atherosclerosis is considered by many to be an indispensable disease of old age. However, when checking older people, not everyone has obvious signs. It has been established that the “preferred” contingent is as follows:
- people with burdened heredity (family members have hypertension, myocardial ischemia, past strokes),
- physically weak
- with limited motor mode,
- prone to overeating and overweight,
- surviving emotional stress and having a profession with great nervous tension.
What happens to blood vessels in the latent period?
It is wrong to choose one of the reasons and limit oneself, for example, to just the nutritional factor (nutrition). The appearance of a plaque narrowing the artery is preceded by a long period, starting from childhood. Non-stenotic atherosclerosis has to go through certain stages.
In the dolipid period, vessels undergo frequent spasm. Of primary importance are the factors involved in responding to stressful situations, including pituitary-adrenal changes. For the progression of atherosclerosis, increased permeability of the vessel, a change in the structure of the wall is necessary. This role is played by infectious agents, a breakdown of innervation.
Lipoidosis occurs when fatty inclusions freely penetrate into the wall of arteries from the lumen of the vessel along with blood plasma.
The amount of lipids supplied with food is 10 times less than that synthesized inside the human body. The fatty substances into which cholesterol breaks down during “precipitation” have been established: triglycerides, α-lipoproteins and β-lipoproteins. These are protein-fat complexes differing in the proportions of protein and fat (in α-lipoproteins, 39.3% lipids and 60% proteins, in β-lipoproteins, 76.7% lipids and 43% protein). Due to fat overload, β-lipoproteins are less stable and break down easily, releasing soluble lipids.
The enzyme lipase is involved in triglycerides. It breaks down compounds to form β-lipoproteins. Therefore, in the formation of cholesterol deposits of blood vessels, the importance of reduced lipase activity is attached.
What symptoms can be presumably associated with the initial period of atherosclerosis?
Early atherosclerotic changes in blood vessels are not accompanied by severe clinical symptoms, therefore, they are usually not diagnosed. The initial period or non-stenotic form of the course can be assumed on the basis of neurovascular and metabolic disorders:
- tendency to general or regional spasms,
- an increase in blood cholesterol and a change in the composition of lipoproteins,
- identification of vascular pathology during the examination.
Most often, non-stenotic atherosclerosis affects the brachiocephalic arteries, aorta, and vessels of the lower extremities.
There are 2 stages of the disease:
- with clinical signs.
It is known that clinical signs appear when narrowing half the diameter of the vessel or more. Then the patient will definitely feel the changes in his condition.
Spastic contractions of the arteries of the brain cause these early symptoms:
- attenuation of attention
- memory impairment
Preclinical symptoms should be addressed by the doctor with leading questions. The general view of the patient indicates premature aging:
- dry wrinkled skin
- thinning and hair loss,
- broken nails
- gait in small steps
- change in character and intelligence.
In the initial stage of atherosclerosis of the brachiocephalic arteries (they include a complex of the right subclavian, carotid and vertebral) during a patient survey, you can identify:
- headaches with nausea and dizziness with normal blood pressure,
- tinnitus, amplified by head movement,
- the appearance of general weakness,
- numbness of the lower extremities,
- decreased vision, periodically darkening, "flies" and "snow flakes" in the eyes.
With preclinical damage to the aorta, atherosclerosis is possible in any of its departments, both in the thoracic and in the abdominal. The patient has:
- discomfort in the heart,
- periodically bouts of abdominal pain not related to eating,
- unexpectedly revealed elevated systolic (upper) pressure,
- hoarseness of voice and cough without cold symptoms.
At the beginning of atherosclerosis of the arteries of the lower extremities indicate:
- limping while walking due to pain in the calf muscles,
- the disappearance of pain on their own after rest,
- leg cramps at night
- chilly feet even in warm conditions.
Simple diagnostic features that all doctors are aware of include:
- increased systolic pressure with normal figures of the lower level, pronounced noise during auscultation on the aorta with aortic atherosclerosis,
- reduced temperature of the affected foot to the touch, inability to determine pulsation on the back of the foot, determination of the ankle-brachial index (measure pressure on the leg by applying a cuff just above the knee and in the usual way on the arm), the ratio of the values should be 1, with a decrease in the coefficient to 0.8 we can conclude about sclerosis of the vessels of the legs.
- rheoencephalography - allows you to establish a decrease in brain nutrition through the leading arteries,
- rheovasography - a similar method used to check vessels of other areas,
- angiography - contrast medium fixes the appearance and patency of arteries on radiographs,
- X-ray of the heart in two projections - shows the state of the aortic arch,
- Ultrasound of the carotid arteries - visualizes narrowing at the level of bifurcation,
- Doppler scanning of blood vessels - a technique for studying the size of a vessel, blood flow velocity, contours and wall density,
- isotope scanning is an expensive study carried out in specialized centers.
What are complications?
The transition of the non-stenotic process to narrowing with the development of subsequent ischemic, thrombonecrotic and fibrous stages can be considered a complicating mechanism.
- In the stage of ischemia, the patient suffers from the classic manifestations of coronary heart disease with typical bouts of angina pectoris, chronic ischemic brain failure forms, blood flow through the renal arteries, femoral and mesenteric vessels suffers.
- Thrombonecrotic complications - characterized by symptoms of acute impairment of blood flow: myocardial infarction, stroke, thrombosis and embolism of other vessels.
- In the fibrotic or sclerotic stage, the organ parenchyma is replaced by scar tissue, their function is sharply reduced, the symptoms indicate insufficiency of the heart, brain, kidneys and liver. These changes are irreversible.
The causes of the disease
The first and most important cause of atherosclerosis is age-related changes in the vessels, which can be triggered by various factors. The disease in the initial stages may not manifest itself in any way, so most people do not even suspect that they have problems with the vessels.
The stenosing type of atherosclerosis most often appears in the male representatives, while the female half of humanity practically does not suffer from this ailment.
In addition to the age factor, the appearance of atherosclerosis of the stenosing species is also affected by:
Among these factors, bad habits are considered the most important. They provoke the development of atherosclerotic changes in the vessels. The second predisposing factor is malnutrition, which contains a large amount of cholesterol harmful to the body. Harmful cholesterol does not completely dissolve in blood plasma, it leaves a precipitate, which settles on the walls of blood vessels, forming atherosclerotic plaques.
The vessels of the lower extremities are most susceptible to atherosclerotic changes. Of course, other vascular systems also suffer from stenotic atherosclerosis, but the vessels of the lower extremities are most prone to changes. This is explained by the fact that the vessels on the legs are below all other vessels, no matter how strange it all sounds.
The most detrimental effect on the vessels is intoxication with alcohol and nicotine. Nicotine in cigarettes can cause cramping in blood vessels. Alcohol has a bad effect on the human nervous system and causes an increase in cholesterol.
In addition, the lifestyle of a person and his working conditions also affect. If a person leads an inactive lifestyle and works in a warm, comfortable office, then after 10 years of such a life, he is provided with atherosclerosis in almost a hundred percent of cases. In order for the vessels to be in good shape, a person must walk at least 10 kilometers every day, and with this way of life it is practically impossible.
Also, local factors can affect atherosclerotic diseases of the lower extremities:
Varieties of stenosing atherosclerosis. Brachiocephalic atherosclerosis of the stenosing type
There are several types of atherosclerosis. The most dangerous variety can be called atherosclerosis of the carotid (or, scientifically, brachiocephalic) arteries. These arteries are vital because they transport oxygen-rich blood directly to the brain.
Atherosclerosis, the carotid arteries can only be affected if other vascular systems of the body are affected.
Signs of stenosing atherosclerosis of the brachiocephalic arteries:
These signs can be signs of not only atherosclerosis of the carotid arteries, but also other vessels. To find out exactly what type of atherosclerosis you are sick with, see your doctor.
The main cause of atherosclerotic carotid artery disease is the appearance of plaque. Basically, atherosclerotic plaques appear due to an improper lifestyle (the use of animal fats in large quantities).
Symptoms of the development of the disease
Symptoms of the disease can be different. It all depends on which vessels were affected. For example, atherosclerosis of the lower extremities can manifest itself in the appearance of snoring at night during sleep. However, this may be a consequence of another form of atherosclerosis.
So, at the first stage, atherosclerosis of the obliterating type can manifest itself as follows:
In the second stage of the disease, leg pain and rapid tiredness of one of the limbs may be added to the previous symptoms. Also, toenails can begin to break and roughen, unpleasant sensations will appear in the calves. Symptoms of coronary disease will appear. In addition, the pulsation on the vessels on the legs will decrease.
During the third stage, lameness will intensify.Every fifty to seventy steps will have to make a stop. Finger pain will appear even during rest. The calf muscles partially atrophy. Hair will begin to fall out, the skin will become thin and inconspicuous, cracks will appear on the fingers.
The fourth stage of the disease is the most serious, its processes are almost irreversible. The skin turns red with a copper tint. The feet will begin to swell, trophic ulcers will appear. At night, mild pain will begin, which will intensify over time. Often body temperature will be elevated. The worst manifestation of the disease is the appearance of gangrene, in which case there is practically no chance of recovery.
Stenosing atherosclerosis of the main parts of the brain
Stenosing atherosclerosis of the main arteries of the head can cause brain failure. Atherosclerotic plaques that are in the carotid and other arteries that transport blood to the brain are most dangerous, since they will grow much faster in these places than in other places.
Symptoms of Brain Deficiency
In this case, three different groups of symptoms can be distinguished. Cerebral symptoms include:
- Bad memory
- Decreased brain activity and stamina,
The manifestations of the ocular nature include:
- Partial blindness, “seizures” of blindness,
- Speech Disorders
- Asymmetry of the face
- Pain and disturbance during movement in the limbs.
BCA stenosing atherosclerosis is characterized by the following manifestations:
How to diagnose a disease?
To diagnose cerebrovascular disease, an ultrasound scan is necessary. This can be done on a modern ultrasound machine, which has a vascular sensor.
Only a study using duplex ultrasound can diagnose damage to the carotid arteries in humans. The study will help not only diagnose the disease, but also accurately determine its stage. An ultrasound machine can determine how much the vessels are narrowed, where the plaque (narrowing) is located, the speed of blood flow, as well as its direction.
Treatment is prescribed exclusively by a medical professional and depends directly on the stage of the disease and its location. Treatment is usually prescribed comprehensively. For example, if a patient has high blood pressure, then he is prescribed drugs that lower him.
- Proper nutrition, in which animal fats are almost completely absent,
- Regular walks for several hours.
In addition, medications that lower cholesterol are prescribed. Before this, the necessary tests are submitted. In especially difficult cases, drugs containing statin are prescribed that suppress the production of cholesterol in the liver. Proper nutrition also almost completely eliminates salt and sugar.
As an additional therapy, you can use traditional and homeopathic medicine. Before using them, be sure to consult your doctor.
The treatment time depends on the individual characteristics of the body, but usually is at least six months. To prevent the development of the disease, follow these recommendations:
- Move more. Walk at least 10 kilometers regularly
- If you work in the office, then every half hour do a little workout,
- Eat properly and balanced, eat less salt and animal fats,
- Give up bad habits. Doctors recommend doing this gradually, but not sharply, so as not to provoke a stressful situation in the body, Obliterating atherosclerosis of the arteries of the lower extremities Cerebral atherosclerosis what is it