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Carotid Artery

20–25% of all strokes are cau­sal­ly rela­ted to a nar­ro­wing of the caro­tid artery (caro­tid steno­sis). Through the tur­bu­lence and acce­le­ra­ti­on of the flow of blood in the area of ​​the blocka­ge, soft plaques, i.e. atheros­cl­ero­ti­cal­ly alte­red vas­cu­lar wall parts, can be torn out and reach the brain. The clog­ging of the cere­bral ves­sels then leads to limi­t­ed blood flow with the risk of a stro­ke that can result in speech dis­or­ders, para­ly­sis or even death. Fre­quent­ly, such blocka­ge is indi­ca­ted in advan­ce by spe­ci­fic sym­ptoms. Typi­cal­ly, in the­se sym­pto­ma­tic pati­ents, short-term visu­al dis­tur­ban­ces usual­ly occur in one eye (amau­ro­sis fugax = short-term blind­ness) or the­re may be para­ly­sis of the arm, hand or leg, which is also known as a tran­si­ent ischemic attack (TIA). Sym­ptoms often dis­ap­pear com­ple­te­ly within a short time. They should, howe­ver, be taken serious­ly. To avo­id an impen­ding stro­ke, a quick cla­ri­fi­ca­ti­on must be made.

Asym­pto­ma­tic caro­tid steno­ses are often dis­co­ver­ed as part of rou­ti­ne con­trols. The­se blocka­ges of the caro­tid artery would not have been pre­vious­ly noti­ced becau­se of a tran­si­ent ischemic attack. Asym­pto­ma­tic steno­ses that show an increase in vas­cu­la­riza­ti­on over a peri­od of time must be cri­ti­cal­ly asses­sed. Pati­ents with asym­pto­ma­tic steno­ses should, based on their risk pro­fi­le, be exami­ned and trea­ted indi­vi­du­al­ly depen­ding on how things progress.

The dia­gno­sis of caro­tid steno­sis is pri­ma­ri­ly arri­ved at by means of vas­cu­lar ultra­sound. This is in addi­ti­on to the assess­ment of blood flow in the head by means of com­pu­te­ri­zed tomo­gra­phy (CT) and/or magne­tic reso­nan­ce angio­gra­phy (MRA).

  • Caro­tid TEA: Throm­bo­en­dar­te­rec­to­my of the Caro­tid Artery

The clas­sic the­ra­py for caro­tid steno­sis is open sur­gi­cal throm­bo­en­dar­te­rec­to­my (caro­tid TEA). The super­fi­ci­al caro­tid artery is sur­gi­cal­ly expo­sed via a small incis­i­on on the neck. This can be done in regio­nal (awa­ke) or gene­ral anaes­the­sia. The dan­ge­rous plaques are com­ple­te­ly remo­ved from the ves­sel (strip­ped) and can no lon­ger cau­se sym­ptoms in the future.

Throm­bo­en­dar­te­rec­to­my of the caro­tid artery is one of the most sci­en­ti­fi­cal­ly stu­di­ed ope­ra­ti­ons. The effec­ti­ve­ness of caro­tid TEA to pre­vent strokes has been undis­pu­ted for many years and is, the­r­e­fo­re, the gold stan­dard in the tre­at­ment of caro­tid stenosis.

  • Caro­tid Stent

As an alter­na­ti­ve to caro­tid TEA, the­re is the pos­si­bi­li­ty of endo­vas­cu­lar the­ra­py (caro­tid stent/CAS) of the caro­tid artery. By inser­ting a metal mesh (stent), the plaque/blockage is pres­sed against the ves­sel wall and thus remains per­ma­nent­ly in the ves­sel. Based on the cur­rent stu­dy results, we only recom­mend endo­vas­cu­lar the­ra­py under spe­cial con­di­ti­ons and accor­ding to the indi­vi­du­al risk pro­fi­le of the patient.