Carotid and Vertebral Angioplasty
Carotid and vertebral angioplasty is a minimally invasive procedure performed to clear the carotid arteries (main arteries that supply blood to the brain) and vertebral arteries (main arteries that carry blood to the brain stem).
In the vast majority of cases, the obstruction of these arteries is caused by fatty and calcium plaques (atherosclerotic plaques) that accumulate on the arterial wall, leading to a picture of stenosis (decreased diameter of the artery). The formation and accumulation of these fatty plaques are one of the main causes of stroke in the elderly.
The clearing of the carotid and vertebral arteries is performed by means of catheterization, with the placement of a stent to cover the plaque and then a balloon is used to restore the normal caliber of these blood vessels.
Stenosis of the carotid arteries or vertebral arteries can be asymptomatic and in these cases they are diagnosed in check-up tests, such as Doppler, CT angiography or magnetic resonance angiography. It is good to remember that even asymptomatic lesions can cause silent strokes.
When symptomatic, these lesions usually manifest with a picture of cerebral ischemia (CVA). Normally, this ischemia can be caused by three different mechanisms: the most common is a part of the fatty plaque breaking off and obstructing a smaller artery. Another form of stroke resulting from atherosclerotic plaques occurs when these are very bulky and obstruct the entire lumen of the artery, which can lead to very severe ischemia. The third mechanism of ischemia occurs when, due to severe stenosis, the brain does not receive enough blood and some more sensitive regions receive less blood supply than necessary.
Other less common symptoms resulting from severe atherosclerotic lesions in the carotid and vertebral arteries are dizziness, fainting, altered cognition.
Asymptomatic lesions that have never caused silent ischemia are only treated in cases of very severe stenosis (above 80%) or if they have other associated symptoms such as fainting and dizziness, without other causes.
Carotid stenosis that has already caused cerebral ischemia (stroke) should be treated when the lesion determines a reduction in the artery caliber above 50% or if the plaque shows signs of instability that can increase the chance of stroke recurrence, such as ulceration and hemorrhages. The indication for this treatment is the prevention of recurrence of cerebral ischemia.
Carotid and vertebral angioplasty is a minimally invasive technique where it is not necessary to open the patient’s skull or cervical region for the treatment of the lesion. The surgery is performed endovascularly, that is, inside the arteries. To do this, it is necessary to perform a puncture of an artery in the patient’s leg, at the height of the groin (femoral artery) or in the arm (radial or brachial artery) and take a catheter to the region.
Once the region of the atherosclerotic plaque is reached, a stent is released covering the entire lesion, causing the entire extension of the plaque to be stuck against the artery wall, thus preventing the migration of new pieces of thrombus into the cerebral circulation. After placement of the stent, a balloon is inflated that will restore the original caliber of the artery, thus restoring the original cerebral flow.
There are several types of stents and balloons that are able to treat carotid artery stenosis. The choice of the most suitable material will depend on the characteristics of the lesion and the patient, therefore, the choice of the best technique is individualized.
No surgical incision is needed, just a small hole in the skin that doesn’t need special dressings.
What causes blockage of the carotid and vertebral arteries?
The main cause of obstruction of the carotid and vertebral arteries is atherosclerotic disease.
Atherosclerosis is the accumulation of fatty plaques in the vessels and can affect any artery in the body.
When it affects the carotid arteries or vertebral arteries, it can generate Ischemic Cerebral Vascular Accident (CVA), popularly known as “Spill”.
Why do I need a carotid angioplasty?
Carotid artery disease has as its main consequence strokes.
The brain needs a constant supply of oxygen and nutrients to function. Even a small transient interruption in the blood supply can cause serious problems. Brain cells begin to die after just a few minutes without blood or oxygen. If the narrowing of the carotid arteries becomes severe enough to block blood flow, or if a piece of this plaque breaks off and migrates into a distal arterial branch and blocks blood flow, an ischemic stroke or stroke can occur. transient ischemic attack (TIA).
What type of anesthesia is needed for carotid angioplasty?
Carotid angioplasty is performed under sedation.
Are there any risks related to the procedure?
Every medical procedure has some risks. However, in general, the interventional methods are those with the lowest rates of complications.
Of the possible risks, the main ones are observed at the puncture site in the groin or wrist, such as a hematoma.
More serious complications such as cerebral ischemia and cerebral hemorrhage can occur, but they are very rare events.
