Arterial pathology

Carotid artery stenosis

Main cause of brain stroke (paralysis, paresis, impaired speech and vision, loss of memory), particularly in subjects smoking, hyperlipidemics, hypertensive, diabetics .. It can cause TIA (transient ischemic attack), hall of stroke. After myocardial infarction is the second leading cause of death and affects the arteries that are bringing blood to the brain, particularly the carotid and vertebral artery. Those arteries may be affected by the atherosclerosis with progressive reduction of the caliber of the lumen by arterial plaques.
The surgical indication for carotid endarterectomy , preferably under local anesthesia or general anesthesia with consciousness conserved with Remifentanyl, is mandatory when the stenosis is> 70% of the lumen, or is present a soft plaque, little calcifications and, sometimes, ulcers, or has already, however, caused symptoms of cerebro-vascular insufficiency.

 The CEA (carotid endarterctomy) consist in the removal of the atherosclerotic plaque causing  stenosis, the application of a patch for  the enlargement of residual lumen or with the detachment of the internal carotid artery for "eversion", removal of atherosclerotic plaque and hang up the internal carotid artery to the carotid bulb.
In particular conditions (stenosis recurrence, neck subjected to radiation, age, general conditions) may be indicated  the endovascular percutaneous treatment through the introduction of vascular catheters into the femoral artery to the inguinal region with angioplasty and stents insertion.
It is recommended to citizens aged over 65 years to submit to an examination of the supraortic trunks Ecocolordoppler for prevention of stroke. (To see the book page "Vascular Laboratory").

 What is the stroke
The stroke is a very widespread in industrialized countries particularly in the elderly but can also affect young people. Take place in Italy around 190,000 cases of stroke annually.
The onset is sudden with two possible causes:

1. cerebral ischemia for the closure of the artery (carotid) that brings blood to the brain or an embolus, usually home by the carotid artery or the aortic arch, o from the hearth blocking blood to a portion of the brain that "dies" (cerebral infarction);
2. cerebral bleeding, which is the rupture of a blood vessel, with flooding and destruction of brain tissue.

 As can be seen
 According to the brain involved, symptoms can be different. Frequently occurs with difficulty or impossibility of the movement of the limbs of one side of the body. Other symptoms can be varied as the difficulty in speech (dysarthria, aphasia), or 'inability to understand or express themselves and impaired vision (amaurosis fugax or complete blindness, impaired visual field, double vision) and so on, to reach a more or less important compromise of the conscience, and the state of coma and / or death.