Carotid artery occlusion is a pathology characterized by partial or complete occlusion of the lumen of the carotid arteries that carry blood to the brain. This disease causes ischemic changes in the cerebral tissues, the severity of which will depend on how developed the vascular collaterals are.
A collateral is a bypass route of blood flow, which provides blood flow outside the main vascular trunk when its permeability is compromised. In this article, we will discuss the clinical signs and treatment of carotid artery occlusion.
What is carotid artery occlusion?
Carotid artery occlusion is a frequent cause of ischemic stroke, transient ischemic attacks. The most frequent occlusion of the carotid arteries lumen is due to the formation of atherosclerotic plaques. Much less often other factors play their role, such as vascular damage, clot formation, compression of vascular structures by tumors and so on.
As we have said, collaterals are bypass vessels that carry out circumferential blood flow in situations where blood flow through the main vascular trunk is not possible. In carotid artery occlusion, collaterals can occur at different levels.
When the patency of the internal carotid artery is impaired, the most common case is the origin of a branch from the internal carotid artery in the area of the cavernous sinus with the subsequent creation of an anastomosis between it and a branch of the external carotid artery. It is through this anastomosis that the collateral circulation is carried out.
How is carotid artery occlusion manifested and treated?
The accompanying symptomatology will depend on exactly what level of vessel passage is impaired, how quickly the occlusion occurred, and how developed the vascular collaterals are.
If the occlusion increases gradually, the collaterals usually manage to more or less compensate the resulting blood supply insufficiency, a clinical picture of chronic ischemic brain damage develops. If vessel patency is suddenly impaired, ischemic stroke may occur.
The most common first sign of carotid artery occlusion is transient ischemic attacks, which may manifest as incoming motor, sensory, visual, or some other disturbance.
Statistics show that the risk of ischemic stroke within the first year after a transient ischemic attack is 13-26%. At the same time, every third patient develops a stroke without a previous transient attack.
More often than not, carotid artery occlusion necessitates surgical intervention. The choice of a specific surgical tactics will depend on many factors – localization of the occlusion, the state of collateral blood flow, and so on. For example, carotid endarterectomy is effective for internal carotid artery occlusion accompanied by transient ischemic attacks, which was proved by scientists from South Ural State Medical University in a paper published in 2016.
Sources used
- Cardiovascular Anomalies By Lee B. Beerman , MD, Children’s Hospital of Pittsburgh of the University of Pittsburgh School of Medicine
- Internal carotid artery occlusion: operative risks and long-term stroke rates after contralateral carotid endarterectomy
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