07 July 2012

Carotid Artery Disease

Carotid artery disease is still a public health problem, it is associated with increased risk of incident ischemic stroke and embolic stroke. One report states that insident ischemic stroke increased with increasing age, ie 33% before the age of 45 years and 80% after 50 years, while the cause of all cases of the 20% to 30% due to carotid arterial stenosis.

Carotid artery stenosis disease can be found by chance, in these patients usually asymtomatis and found along with other vascular diseases, such as stenosis at: coronary arteries, lower extremity and renal arteries. In patients with clinical presentation can be symtomatis Transient Ischemic Attacks (TIA) or ischemic stroke due to occlusion severe subtotal / total occlusion in one or both arteries and karotis.2

Treatment involves the treatment of carotid artery stenosis Medical, surgical carotid endarterectomy (CEA) and Angioplasty. Medical treatment has not been shown to eliminate the carotid artery stenosis, treatment aims to treat the risk factors and slow the progression of plaque stenosis, but efficacy against Cerebral Ischemic Events are still being debated.


CEA can not be performed on all patients, for example, more than 79 years of age, patients with heart disease / kidney / liver weight, abnormalities of the valve / dysrhythmias are at risk of embolism, patients with angina / myocardial infarction within 6 months, patients who underwent major surgery less of one month, and patients who refuse oprasi action.

In this condition Carotid Angioplasty is preferred as a therapeutic option because of a simpler, broader patient selection and less invasive. The following will be reported cases of carotid PTA-stenting in patients who experience a TIA and coronary heart disease.

Right carotid artery is a branch inominata originating from the right aortic arch. The left common carotid artery originated directly from the aortic arch. At the thyroid level, common carotid artery forked into the internal carotid artery and external carotid arteries. Located near bifurcations, in the carotid sinus, the carotid chemoreceptors, which are sensitive to carbon dioxide and oxygen content of blood, and baroreceptors, which helps regulate blood pressure.

The external carotid artery supplying blood to the head and neck structures, except for the eyes and brain. Internal carotid artery causing the artery posterior cerebral artery ophthalmicus and associated with anterior cerebral artery and middle cerebral artery, which helps supply blood to the brain. Patients with carotid artery occlusive disease can experience a sudden dysphagia, unilateral motor weakness, expressive aphasia, dizziness, memory deficits, or monocular blindness. They often show signs of vascular disease in other parts of the body, such as the heart (coronary artery disease) or legs (peripheral arterial disease).

Risk factors for carotid artery occlusive disease associated with stroke and should guide patient care. Hypertension is the most important risk factor for stroke, and blood pressure regulation is very important in the postoperative period. Problems such as smoking, hyperlipidemia, alcohol consumption, and use of postmenopausal estrogen can also affect patient care. Patients with risk factors for carotid arterial occlusive disease should be examined carefully.

Carotid bruit can usually auscultated in the arteries due to turbulent flow through narrow arteries. Carotid Doppler ultrasound is usually performed to estimate the presence and amount of stenosis, but angiography is the most reliable method to determine the exact amount of stenosis. Magnetic resonance angiography, less invasive, can also be performed.

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