Stroke is the sudden, rapid and progressive deterioration of neurological functions that develops due to inflammation in the brain, medulla spinalis and retina, that is, blood flow disorder. The neurological dysfunction that occurs here lasts longer than 24 hours. Ischemic strokes constitute 80% of all strokes, and 10-30% of these patients result in death.
Transient ischemic attack (TIA or TIA), as the name suggests, occurs due to ischemia of the brain, medulla spinalis or retina. It is a temporary neurological dysfunction. If the findings last less than 24 hours, it is defined as TIA.
10-20% of patients with TIA are candidates for stroke within the first three months. In this respect, patients who are older, diabetic, and whose complaints last more than 10 minutes during a transient attack are at high risk.
The most important source of ischemic cerebravascular events outside the brain is atherosclerosis affecting the carotid bifurcation, that is, fatty plaques formed in the bifurcation area of the carotid artery that feeds the brain. .
A patient with neurological symptoms should be evaluated by a neurologist to understand whether the symptoms are caused by carotid stenosis or another cause. Neurological findings due to carotid fatty plaque can generally manifest as a combination of symptoms such as tingling, weakness and paralysis in the limbs on the opposite side of the disease, or the inability to speak and vision loss.
The diagnosis of carotid artery stenosis is easily accessible, inexpensive and non-invasive. Since it is a method that does not involve radiation, the most commonly used diagnostic method is color Doppler ultrasonography. In addition, computed tomography and magnetic resonance (MR) angiography are other non-invasive tests. Digital subtraction angiography, or DSA, is still accepted as the gold standard in the diagnosis of the disease. However, it is recommended to use it simultaneously with the treatment in cases examined with non-invasive methods, in cases of incompatibility or inadequate evaluation of these results, or in patients who are planning endovascular treatment.
In planning the treatment of the disease, neurological symptoms, the degree of carotid stenosis and the plaque causing the stenosis are recommended. Finally, the anatomical structure of the vein is important.
Carotid Artery (Carotid Vein) Treatment
Medication treatment, surgical repair and endovascular methods, that is, intravascular stent applications, are among the alternatives. In medical treatment, quitting smoking, regular exercise, a normal body mass index and a Mediterranean diet are extremely important. Control of blood pressure and cholesterol, especially bad cholesterol, which we call LDL, must be kept below 100 mg/dl. Diabetic patients should also have strict blood sugar control. HbA1c value should be 7%. At the same time, patients should be started on appropriate blood thinner treatment.
It has been shown that surgical treatment is superior to drug treatment in suitable patients with carotid artery diseases. In surgical treatment, under general or regional anesthesia, the narrow area in the carotid artery is opened, the fatty plaque causing the stenosis is removed, and then the vessel is closed either by direct stitching or with the help of a patch.
Another treatment option for carotid artery disease is endovascular methods. that is, intravenous stent application. Carotid artery stenting can be performed safely in experienced centers in patients with high surgical risk due to additional diseases such as severe heart failure or COPD, or in patients who are not suitable for surgery due to the location of the stenosis in the vessel.
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