Brachiocephalic occlusive disease
General information
Brachiocephalic occlusive disease, or atherosclerotic lesion of the brachiocephalic arteries (BCA), is a type of atherosclerosis in which the carotid and vertebral arteries undergo sclerotic changes. They are the primary source of blood supply to the cerebral hemispheres. Lipid deposits on their walls create an obstacle to blood flow, which leads to acute disorders of cerebral circulation: ischemic attacks, strokes, and other severe and often irreversible consequences. Timely diagnosis of the disease significantly increases the chances of its successful treatment, which is carried out exclusively by surgery in advanced stages.
Types of BCA atherosclerosis
Depending on the state of the vascular wall, the degree of narrowing of the brachiocephalic arteries, as well as the severity of signs of the disease, non-stenotic (hemodynamically insignificant) and stenotic (hemodynamically significant) atherosclerotic lesions of the BCA are distinguished.
- Hemodynamically insignificant. Atherosclerotic plaques slightly narrow the lumen of the internal carotid artery, which does not lead to impaired blood circulation in the brain. They require dynamic observation by a cardiovascular surgeon and instrumental control. Conservative manipulations aimed at stabilizing and slowing the growth of atherosclerotic plaques are mandatory.
- Hemodynamically significant. Atherosclerotic deposits significantly narrow the lumen of the internal carotid artery and threaten the development of cerebral circulatory disorders (stroke or transient neurologic changes). In such a vascular lesion, surgical intervention is indicated to restore normal patency of the artery, normalize blood supply to the brain, and prevent possible stroke.
Complications
The most dangerous complication of atherosclerotic lesions of intra- and extracranial BCA is acute cerebral circulatory failure. It is accompanied by a sharp deterioration in the supply of brain tissue with oxygen and symptoms of impaired functioning of the affected department. Two types of conditions are distinguished:
- transient ischemic attack (TIA): the disorders are entirely resolved within a day;
- ischemic stroke (cerebral infarction): irreversible changes occur in the nerve tissue.
Stroke can cause a patient’s disability and even death when vital centers of the brain are affected.
Chronic oxygen starvation of brain tissue on the background of atherosclerosis of the BCA can also lead to the development of memory, behavioral, and mental disorders. This disease is one of the mechanisms of the development of senile dementia.
Symptoms of BCA atherosclerosis
Signs of atherosclerotic lesions of the BCA worsen as the pathology develops.
The main symptoms are:
- deterioration of general brain functions: memorization and reproduction of events, ability to concentrate, mental work capacity, etc.;
- periodic mild dizziness, increasing with physical or psycho-emotional stress;
- bouts of intense headaches;
- intermittent tinnitus, similar to the sound of cars passing by;
- decreased visual and hearing acuity;
- memory lapses, speech impediments;
- numbness of body parts, more often unilateral (limbs, face, tongue);
- a complex deterioration of well-being;
- loss of visual fields;
It is important to know that the disease may be asymptomatic at the initial stage. Sometimes, the absence of obvious symptoms can be observed in acute life-threatening conditions.
Reasons
To date, there are several theories for the development of BCA atherosclerosis. Among them are chronic inflammation and/or microdamage of the vascular wall and metabolic disorders. Risk factors that increase the likelihood of developing the disease have been identified:
- imbalance of fats in the blood (dyslipidemia); can be hereditary, caused by external factors (improper diet) or diseases;
- diabetes mellitus and other pathologies accompanied by metabolic disorders;
- arterial hypertension;
- overweight and hypodynamia;
- bad habits, especially smoking;
- chronic stress, lack of sleep;
- age;
- aggravated heredity.
Diagnosis of BCA atherosclerosis
The exact diagnosis is established based on the collection of anamnesis and a number of hardware tests.
- Examination by a neurologist and a vascular surgeon. At the appointment, specialists identify existing symptoms and determine the presence of hereditary and concomitant diseases, bad habits, and other risk factors. External examination and auscultation of the carotid arteries (listening to the pulsation with a stethoscope).
- Ultrasound of brachiocephalic arteries. It is a non-invasive method of ultrasound examination of vessels, which provides information about the speed and nature of blood flow, the state of the arterial walls, the presence and degree of development of atherosclerosis, as well as the anatomical features (tortuosity) of the main vessels (they can also cause nutritional disorders of the brain).
- CT angiography of BCA with contrast. The most informative study that differentiates between healthy and pathologically altered tissues. Introducing contrast agents into the bloodstream helps obtain reliable radiologic information about the presence of atherosclerotic lesions and other deformations of vessels. Angiography allows for the assessment of not only the condition of the arteries but also their filling, giving visualization of their significant areas in real-time.
Treatment
Conservative treatment is promising only at the initial stages of pathology development. It includes a set of measures aimed at slowing or stopping the development of pathology and eliminating vascular insufficiency of the tissues of the head, primarily the brain. Treatment tactics are chosen personally depending on age, the degree of atherosclerotic lesion of the BCA, and other individual factors. The basis is conservative therapy:
- medications to lower blood cholesterol levels;
- antiplatelet drugs;
- drugs that improve brain function (nootropics), etc.
It is important to correct lifestyle. Patients need to follow a diet that limits saturated fats, avoid hypodynamia, provide themselves with regular, feasible physical activity, and get enough sleep.
Surgeries for atherosclerotic lesions of the BCA
Surgical intervention is indicated in the absence of medication effect and in total atherosclerotic lesions of the carotid arteries (performed in 60-70% of cases). The grounds for surgery are plaque instability and episodes of transient ischemic attack (TIA). The need for surgical treatment and its method are determined individually
in each case.
Angiologists perform carotid endarterectomy or endovascular stenting depending on the extent, degree, and location of the affected area.
Carotid endarterectomy
It involves removing atherosclerotic plaque from the vessel lumen through a surgical incision and subsequent suturing of the vessel. It is performed under general anesthesia.
Endovascular stenting
The intervention is performed without surgical incisions and under local anesthesia. Through a small puncture on the thigh, instruments are inserted into the vessel, and painless compression of the atherosclerotic plaque with a special stent is performed with complete restoration of patency of the narrowed area. Endovascular revascularization (restoration of normal perfusion) is a high-tech, minimally traumatic intervention performed under radiological control on a modern angiographic machine.
All these treatment options are available in more than 530 hospitals worldwide (https://doctor.global/results/diseases/brachiocephalic-occlusive-disease). For example, Carotid angioplasty and stentingcan be performed in 17 clinics across Turkey for an approximate price of $8.2 K(https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/carotid-angioplasty-and-stenting).
Postoperative rehabilitation
After open surgery, the period of hospitalization is 6-7 days. Endovascular intervention is performed under local anesthesia, reducing the recovery time by 2-3 days. In case of positive dynamics, the patient is discharged home with recommendations to limit increased physical activity and thermal overload for 1-1.5 months.
During the recovery period, it is necessary to completely exclude smoking and drinking alcohol of any strength, adhere to the diet, and reduce contact with strangers and recently ill relatives.
Prevention
The main method of prevention of BCA atherosclerotic lesions is lifestyle correction. Following methods are usually recommended:
- to maintain an average body weight;
- avoid hypodynamia;
- adhere to the principles of proper nutrition (balanced in terms of essential macro- and micronutrients);
- minimize stress;
- stop smoking and drinking alcohol.
It is important for patients with diabetes mellitus to control their blood glucose levels and for people with arterial hypertension to control their blood pressure. It is also important to realize that the initial signs of atherosclerotic lesions of the brachiocephalic arteries may be absent or insignificant for a long time. People at risk should undergo regular examinations to detect changes in time.
