What is Carotid Artery Occlusive Disease?
The carotid arteries are the primary arteries, located on either side of your neck, that supply blood to your brain. Carotid artery occlusive disease is caused by atherosclerosis. 动脉粥样硬化斑块积聚在动脉壁上，导致动脉狭窄。, 或者变得很厚，完全阻塞了血液的流动(闭塞). This disease process increases your risk of having a stroke. Approximately 20% of strokes are related to this disease.
What are the Symptoms of Carotid Artery Disease?
Most people with carotid artery disease don’t have any symptoms. 当你的医生在检查你颈部的颈动脉时听到一种被称为“杂音”的声音时，这种情况可能会在体检中被发现.“这可能代表血液通过狭窄动脉的粗糙或快速流动. 患有脑卒中或卒中高危因素的患者应进行颈动脉疾病筛查.
最常见的症状是短暂性脑缺血发作(tia)，通常被称为“小中风”.” The symptoms of a TIA last from a few minutes to 24 hours. 当斑块表面的一块斑块或血凝块脱落并进入大脑时，就会发生TIA. Imaging scans of the brain don’t show any signs of a stroke. 这些症状是短暂的，因为身体能够分解血块或斑块，血流恢复到受影响的大脑区域. Common symptoms include:
- 口齿不清
- Weakness of an Arm and/or Leg on the Same Side of the Body
- 身体同一侧的手臂和/或腿麻木刺痛
- Visual Loss, in One Eye
- 不稳定的步态
- 失去协调性
A person suffering a TIA is at increased risk for a major stroke. You should report TIA symptoms to your physician immediately. 不要忽视他们. One in three people who have a TIA will go on to have a stroke. 短暂性脑缺血发作是一个警告信号，需要进行全面的评估，并了解你和你的医生可以做出哪些改变来预防中风. 大约50%的中风患者会死于中风. Of those who survive a stroke, 大约50%的人会有一些永久性的神经损伤，如失去手臂或腿或无法说话.
How Can I Know if I Have Carotid Occlusive Disease?
颈动脉超声用于颈动脉闭塞性疾病的筛查和监测. This test detects most cases of carotid artery disease. 它能告诉你颈动脉的狭窄程度以及血液流过颈动脉的速度. 偶尔需要额外的研究来确认堵塞或观察大脑本身.
- CT扫描和CT血管造影(CTA): CT和CTA扫描以许多薄片的形式拍摄x射线图像. CT scans can show an area of the brain that has poor blood flow. CTA显示了颈部和头部的动脉并能识别动脉狭窄的区域.
- 磁共振血管造影(MRA): MRA使用无线电波和磁场来创建动脉的详细图像.
- 血管造影术:血管外科医生使用血管造影术来更好地观察解剖结构，并在颈动脉血管成形术和支架置入术中常规使用. 造影剂通过导管注入动脉, and then live x-ray images are viewed. 这些图像显示了血液流经动脉和动脉变窄的位置.
Treating the Risk Factors: A Common Theme in Vascular Disease
颈动脉闭塞性疾病的危险因素和建议的生活方式改变与其他血管疾病相同:
- Family History of Stroke
- Coronary Artery Disease
- Previous Myocardial Infarction
- Peripheral Vascular Disease
- 糖尿病: Maintaining Control of Blood Glucose. 定期筛查所有心血管疾病是至关重要的，因为糖尿病患者患所有这些疾病的风险都在增加.
- Obesity: Obtain a BMI < 30
- 高胆固醇:控制饮食，如果你的初级保健医生建议服用他汀类药物.
- 高血压:通过运动、饮食和必要的药物来控制.
- 吸烟:停止!
颈动脉疾病的治疗计划旨在防止进一步狭窄, 闭塞和中风. 计划从纠正可改变的风险因素开始，比如控制糖尿病, 高血压. 他汀类药物是用于降低胆固醇水平和减少动脉炎症的药物，动脉炎症会导致斑块的增加. 阿司匹林或另一种药物可以防止血小板粘附在斑块上并导致闭塞，这也是通常推荐的. 戒烟对于预防疾病的发展是绝对必要的!
If there is mild to moderate stenosis in the arteries, but you don’t have any symptoms, 我们会定期对你进行动脉超声检查以评估动脉内血流的稳定性. You can have severe narrowing and not have any symptoms. 如果斑块扩大，狭窄变得严重(狭窄超过80%), surgery may be recommended to decrease the risk of stroke, whether or not you have symptoms.
Carotid Endarterectomy: 这个手术可以去除导致动脉狭窄的斑块. 它是通过颈部患病侧的一个小切口进行的. The artery is opened and the plaque is removed. 在移除斑块后，通过在动脉上缝合静脉或人工材料来关闭动脉. 使用补片闭合可减少再狭窄或闭塞的风险. 大多数患者术后一到三天就能回家.
Carotid Artery Balloon Angioplasty and Stenting: 这是一种微创手术，通常使用局部麻醉剂进行. 它已被批准用于治疗有症状的颈动脉疾病的患者，这些患者被认为是颈动脉内膜切除术的高风险患者. To perform this procedure, your vascular surgeon inserts a long, 一根叫做导管的细管穿过腹股沟动脉的小穿刺，通过血管造影术引导它穿过血管到达颈动脉. 导管的尖端有一个小气球，外科医生可以给它充气和放气, flattening the plaque against the walls of the artery. 外科医生在动脉中放置一个微小的网状管，称为支架，以保持动脉畅通. The stent will remain in the artery.