Carotid artery, vertebral artery are the blood vessels in the neck, which supply the brain circulation. There are two carotid and two vertebral arteries present to supply on both sides of the brain. The carotid artery supplies front part of the brain (called cerebrum), where as vertebral artery supplies back part of the brain (cerebellum and brainstem). A partial block in the internal carotid artery is called as carotid stenosis. Carotid stenosis accounts upto 20% of the causes of mini strokes and strokes.
Carotid stenosis is commonly due to a ﬁbrofatty layer (atherosclerotic plaque) at the origin of the internal carotid artery. Diabetis mellitus, hypertension, high cholesterol levels, smoking and family history contribute to form this fatty plaque. Very uncommonly, carotid stenosis may occur due to inﬂammation of blood vessels (eg. ﬁbromuscular dysplasia, takayasu arteritis).
Lifestyle modification is very important step in limiting the disease progression. Optimum control of blood sugar and cholesterol levels cannot be undermined. Antiplatelet agent aspirin with or without other anti platelet agents (eg. clopilet) forms the mainstay of medical management. Patient with carotid stenosis (>70 % stenosis) and history of minor or major stroke on the same side of the brain should undergo carotid revascularization either by carotid stenting or endarterectomy.
Stenting is a minimally invasive method for opening the blocked blood vessels by placing a stent in the artery. Carotid stenting is one of the methods to open (carotid revascularization) the blocked carotid artery (carotid stenosis). Although open surgical endarterctomy is the traditional standard for the treatment of carotid stenosis, carotid stenting of late had been proved to be not inferior to endarterectomy. Both short term and longterm results have shown no signiﬁcant difference in results of stenting and endarterectomy in terms of outcomes and recurrence. (Reference – N Engl J Med 2010;363:11-23 ,’ N EnglJMed. 2016;374:1021-31).
DR.SURESH GIRAGANI CONSULTANT INTERVENTIONAL RADIOLOGIST at Apollo Hospital, has more than Seventeen years of clinical experience in vascular interventions with a special interest in neurovascular and peripheral vascular disease interventional procedures.
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