Our main carotid arteries (popularly known as 'Jugular vein'), located one on each side of our neck, have two main branches as internal and external carotid arteries and then various branches of these. Internal carotid arteries constitute two of the four main vessels that deliver oxygen-rich blood to the brain. External carotid arteries feed the face, neck area and scalp. The development of a high-fat structure called plaque in the inner part of the carotid arteries is called carotid artery disease. It is most commonly caused by atherosclerosis, that is, arteriosclerosis, and most carotid patients are accompanied by cardiovascular or peripheral vascular disease. The vertebral artery feeds the back part of the brain, which runs behind the neck, especially the balance and respiratory-circulatory centers. The incidence of carotid/vertebral/intracerebral artery disease increases with age. Carotid artery disease is a serious condition as it can lead to stroke or cerebrovascular attacks. A stroke occurs when blood flow to the brain is interrupted. If blood flow to the brain is interrupted for more than a few minutes, brain cells begin to die. Stroke can result in brain damage, paralysis, long-term disability and death. Carotid artery disease appears to begin when damage occurs to the inner layers of the carotid arteries for any reason. Factors contributing to this damage are: Use of tobacco and tobacco products, High amounts of fat and cholesterol in the blood, High blood pressure, Insulin resistance or high blood sugar levels due to diabetes. Carotid artery disease may not cause signs and symptoms until the carotid arteries become severely narrowed or completely blocked. Symptoms that may be observed: Various degrees of loss of strength and/or numbness in one half of the body, including the face, difficulty in speaking and understanding, sudden loss of vision in one or both eyes - decrease in vision, dizziness - balance disorder, and sudden onset of severe headache without any reason. . These symptoms, which can sometimes be very short-lived, may be a sign of a severe stroke coming from the back, so a healthcare provider should be consulted.
Carotid / Carotid, vertebral and/or intracerebral balloon angioplasty and/or stenting is used to eliminate stenosis or occlusion of the artery feeding the brain. It is opened either with a wire cage called a stent or usually with both. In this way, the brain will receive better blood supply, and since the clots and plaques in the vessels are fixed, it will be protected from paralysis that may occur in the future. In addition, by increasing the blood supply to the brain, loss of strength after paralysis will be able to recover faster. Where, how and by whom is Carotid / Vertebral / Intracerebral artery balloon angioplasty and/or stenting performed, and what is the estimated duration? Carotid / Vertebral / Intracerebral artery balloon angioplasty and/or stenting is performed in the angiography (or catheter) laboratory on the 2nd floor of our hospital. These procedures are performed by a team consisting of specially trained interventional cardiologists, nurses and technicians. This process takes approximately 30-45 minutes on average. A procedure similar to angiography will be performed. The procedure is performed by directly entering a superficial artery with a needle and vascular sheaths under local anesthesia (regional anesthesia). After entering the artery, thin tubes or tubes called catheters, monitored with x-rays, are advanced to the appropriate vessel leading to the brain. The process of opening or widening the three vessels mentioned above is performed using appropriate materials and devices. After the procedure, the catheter is removed. After the catheter system is removed, you must lie down and remain motionless for a certain period of time (6-12 hours) until the entry site heals. You may be kept in the hospital for a while depending on your clinical condition.
During the procedure, some of the following risks and undesirable situations may occur, depending on your age and current health condition:
Due to infection at the incision site; Redness, pain, discharge or abscess may occur.
The entrance to the artery does not close and blood may collect around it, and the resulting swelling may sometimes need to be drained surgically.
The artery and vein at the entry site may become narrow, and as a result, malnutrition and swelling may occur in the inserted limb, requiring treatment through surgery or angiography.
Arterial blood flow in the leg where the needle is inserted may stop due to undesirable situations. Therefore, treatment through emergency surgery or angiography may be required.
During the procedure, blood Bleeding may occur in the brain or another area that requires emergency surgery when clot-dissolving drugs are given or when clot-dissolving drugs are given.
During the procedure, plaques in the vessels leading to the brain may be broken off by catheters and transferred to the brain, or temporary paralysis, vision-speech problems or paralysis may develop due to the contrast material. Although these risks vary depending on the characteristics of the patient; It is less than 3% in those who have not had a stroke before, and less than 6% in those who have had a stroke. In this case, treatment through emergency surgery or angiography may be required.
During patient follow-up, the vessel in which the stent was inserted may narrow again. This can be reopened using the same method.
Despite the opening of the vein, temporary or permanent paralysis may occur in patients under follow-up due to other factors (arrhythmia, problems in other vessels feeding the brain).
There may be some undesirable situations/risks due to intravenous and intra-arterial administration of contrast material. Renal failure may develop due to contrast material use. The majority of the failure that occurs is temporary. A very low percentage of patients may experience permanent kidney failure and require treatment.
Death is extremely rare. 1-5 deaths occur in every 1000 patients. What kind of problems may be encountered if Carotid / Vertebral / Intracerebral artery balloon angioplasty and/or stenting is not performed even though it is necessary and what kind of procedure should be followed when we decide to have it done? Especially in carotid artery stenosis, even if there are no complaints and if no treatment is given, the risk of mild temporary paralysis varies between 11-66%, and the risk of severe paralysis or death varies between 2-6%. In case of drug treatment, the overall risk of stroke varies between 2-10% annually. If the patient has complaints and the degree of stenosis is high, the risk increases proportionally. If it is later decided to have carotid / Vertebral / Intracerebral artery balloon angioplasty and/or stenting, you can come to the cardiology outpatient clinic and make an appointment and have your angiography done on the given date.
Depending on your situation Rahi therapy may be an alternative treatment method. Surgical carotid endarterectomy also has certain risks and complications. Some important ones are; bleeding, pseudoaneurysm development, stroke, heart attack, cranial or peripheral nerve injury.
Some medications should be used before and after Carotid/Vertebral/Intracerebral artery balloon angioplasty and/or stenting. These drugs are anticoagulant drugs, cholesterol-lowering drugs and drugs for other diseases (diabetes, hypertension). Some of these medications (for example, aspirin or equivalents) can be given orally before the procedure and used for a long time or even for life after the procedure. Patients who undergo this procedure must use their medications as prescribed by their doctor. It is necessary to walk every day and choose cholesterol and fat-free, salt-free foods under the supervision of a dietician.
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