Risk of stroke due to carotid artery stenosis

On September 17, Dr. Nguyen Anh Dung, Head of the Department of Cardiovascular and Thoracic Surgery, Cardiovascular Center, Tam Anh General Hospital, Ho Chi Minh City, said that Mr. Thinh’s right internal carotid artery was 80% narrowed, the left internal carotid artery was slightly narrowed about 30% with atherosclerosis. The right limb ABI index (lower limb arterial pressure compared to upper limb) was 0.6, showing that the right leg blood pressure was much lower than the right arm. Doppler ultrasound of the lower limb arteries recorded severe stenosis of the bilateral femoral arteries. This condition is called polyarteropathy, often found in people with many cardiovascular risk factors (diabetes, dyslipidemia, hypertension, smoking…).

The carotid arteries are the main branches that originate from the thoracic aorta, running along both sides of the neck, supplying blood to the brain. Carotid artery stenosis occurs when the artery wall thickens due to atherosclerotic plaques, gradually narrowing the lumen. This condition can easily cause damage to the brain, manifesting as a transient ischemic attack or stroke. Mr. Thinh’s headache, dizziness, and falls are signs of a transient ischemic attack.

According to Dr. Dung, two surgical methods to treat the disease include surgery and carotid artery stenting. Of these, carotid endarterectomy is the technique that gives the best results. This method is indicated for cases of 60-99% carotid artery stenosis, the stenosis location is favorable for surgery, and the patient does not have a high risk of complications during surgery.

The surgeon removed the inner lining of Mr. Thinh’s right internal carotid artery. The patient’s blood pressure was maintained at 130-140 mmHg to ensure blood flow to the brain and avoid brain damage during surgery. A brain tissue oxygen meter helped the doctor record the blood flow to the brain at each moment to make appropriate adjustments. After more than an hour, the team removed the entire plaque, leaving no atherosclerotic debris in the vessel.

The patient was alert, responsive, and had no post-operative headaches. He was discharged three days later. It is expected that he will continue to undergo interventional treatment for femoral artery stenosis in the near future.

Among the causes of stroke, carotid artery stenosis due to atherosclerosis accounts for about 15%, according to Dr. Dung. Risk factors for atherosclerosis include lipid metabolism disorders, high blood pressure, diabetes, smoking, obesity, and lack of exercise. Stress, abuse of certain drugs such as birth control pills, painkillers, etc. also increase the risk of developing the disease.

Mr. Thinh’s case has many risk factors for the disease including old age, dyslipidemia, diabetes, and atherosclerosis. He also has chronic bone and joint disease and often takes joint medicine of unknown origin to relieve pain. Doctors believe that patients who abuse drugs of unknown origin to treat arthritis for a long time also contribute to accelerating atherosclerosis.

Carotid artery stenosis has few specific signs, so screening helps detect the disease early. Dr. Dung recommends that people at high risk, even if they have no symptoms, should be screened for cardiovascular disease. Patients with carotid artery stenosis who suddenly experience symptoms of crooked mouth, hemiplegia or paralysis of one arm or leg, difficulty speaking or inability to speak, loss of vision on one side, balance disorders, etc., must go to the emergency room immediately.