Carotid Stenting For Recurrent Strokes

The carotid artery is one of the major blood vessels through which blood flows from the heart to the brain.

The carotid vessels despite their major roles (of supplying the precious brain) are not spared from the troubles of life .

For now , let us focus on carotid stenosis (narrowing ) , a common cause of stroke.

Risk Factors For Carotid Stenosis (Narrowing)

  • High cholesterol (fat) levels, especially high “bad” cholesterol , there  is “good” cholesterol.

  • High blood pressure

  • Diabetes

  • Advancing age

  • Obesity

  • Family history of stroke

Symptoms Of Carotid Stenosis ( Narrowing)

  1. Sudden numbness or weakness of the face, arm or leg, usually on one side of the body.

  2. Sudden trouble speaking.

  3. Sudden trouble understanding what one is being told ( comprehension difficulties).

  4. Sudden trouble walking.

  5. Sudden trouble seeing in one or both eyes.

  6. Sudden confusion.

  7. Sudden dizziness.

  8. Sudden loss of balance or coordination.

  9. Repeated sudden, brief loss of consciousness (fainting) , it is also called syncope.

What Is Typical About Carotid Stenosis ( Narrowing) Symptoms ?

  1. Typically, it is symptoms of stroke lasting a few minutes to 24 hours .

  2. Patients often fully recover , even at home.

  3. The attacks may occur multiple times , each being a serious warning of a pending major stroke.

  4. Eventually a full scale ( major ) stroke occurs if the carotid stenosis (narrowing) is not fixed.

How Do I Confirm That I Have Carotid Stenosis ( Narrowing) ?
  1. Carotid ultrasound , also called called carotid doppler.
  2. CT Angiography
  3. MRI Angiography
  4. Brain Digital Subtraction Angiography ; It is the best and gold Standard , the information it gives is unparalleled.

Treatment Of Stenosed (Narrowed ) Carotid

1. Carotid Stenting

A way to treat carotid stenosis ( narrowing) without surgery , i offer this.

2. Surgery

Have colleagues who offer this.

3. Oral Medications

These do not address the narrowing, but atleast reduce the likelihood of getting stroke.

4. Doing Nothing

You just have to live with the effects of carotid stenosis (narrowing) , including a possible major stroke !.

Many options , choice depends on you and how severe your disease (narrowing) is

Medications For Carotid Stenosis ( Narrowing)

This is the go to options for patients with subtle narrowing.

Certain drugs are used to control the likelihood of getting stroke , but never addresses the underlying narrowing.
Various oral medications are key in the treatment of repeated stroke , due to carotid stenosis (narrowing)

Carotid Stenting , A Way To Treat Carotid Stenosis ( Narrowing) Without Surgery

Through a very tiny hole in groin or hand blood vessel , small tubes (catheters) are tracked into the body to the site of narrowing. The narrowed blood vessels is then opened up.
A tiny mesh tube called a stent is usually deployed to open up the narrowed blood vessels. It is done when patient is fully awake.

A carotid stent , when deployed across the narrowed vessel segment , it opens up the vessel.

The stents are best imagined as culverts , specially engineered to maintain blood flow inside the body.

A stent is to the body , what a culvert is to the drainage channel.

Below is a 55 year old with repeated strokes , carotid stenosis (orange arrow) was confirmed.

This was treated by carotid stenting , patient is doing well , now no more strokes.

surgery For Carotid Stenosis ( Narrowing)

A cut is made in the neck , the narrowed blood vessels is opened too.

The material causing the narrowing (plaque) is cut out , and blood vessels stiched again.

This procedure is called carotid endarterectomy.

Below Dr.Paolo from Brazil at it , he generously offered these photos for education purposes , forever indebted.

Step 1

Opening up the neck

Step 2

Exposed neck blood vessels ( Carotid artery) , culprit vessel is cut open to remove the blockage.

Step 3

Material that was blocking the vessel (plaque) has been cut out , and blood vessel closed again.

Frankly speaking , we have done justice to carotid stenosis ( narrowing) , a common cause of recurrent stroke.These strokes are and should be taken as a very serious warning that a major stroke is likely to occur if the blood vessels supplying the brain are not fixed.

The only unfinished business now , is a user friendly discussion on stenosis (narrowing) of blood vessels inside the brain itself , similar presentation of repeated strokes , but ultimately a different treatment strategy.

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