Bilateral common carotid artery sclerosis

Arteriosclerosis mostly occurs in middle-aged and elderly people, and has been tending to occur in younger people in recent years. People should pay more attention to their daily diet, eat more vegetables and fruits, and especially avoid fried and spicy foods. Bilateral common carotid artery sclerosis is a relatively common condition nowadays. In severe cases, it can cause poor blood supply to the brain, leading to serious consequences. Therefore, you must be alert to the symptoms and seek medical treatment as soon as possible.

The two carotid arteries and two vertebral arteries are the basis of brain blood supply. When 1 to 4 of these blood vessels are blocked or narrowed, it can cause severe cerebral ischemia. In European and American countries, the so-called extracranial obstructive cerebrovascular disease caused by arteriosclerosis at the bifurcation of the carotid artery has become quite common, and some of it is caused by arteriosclerosis at the opening of the vertebral artery. In 1995, Mattos reported that there were 2,243 cases treated in a community hospital in the United States. Although extracranial obstructive cerebrovascular disease caused by arteriosclerosis is still rare in my country, the incidence of this disease will continue to increase with the rapid improvement of people's living standards and the continuous changes in eating habits and structure.

Clinical manifestations

The most common clinical manifestations of extracranial obstructive cerebrovascular disease are TIAs and RIND. If incomplete blockage is caused by atherosclerosis at the origin or proximal end of the internal carotid artery, there are two common clinical symptoms: transient monocular blindness (TMB) and transient hemisphere attack (THA). Fisher believed that the embolus originated from artery-to-artery embolism caused by atherosclerotic stenosis and/or ulceration at the origin of the internal carotid artery. If the embolus is very small, it can quickly pass through the branches of the internal carotid artery, the ophthalmic artery, and finally block the retinal arterioles, manifesting as transient amaurosis. Typical patients often describe a curtain in the eye that opens from top to bottom or from bottom to top. Cholesterol luminous bodies, the so-called Hollenhorst plaques, can be seen with an ophthalmoscope. If the embolus is large and affects the branches of larger intracranial arteries, cerebral hemispheric symptoms may occur, characterized by stereotyped and recurrent transient clinical manifestations with contralateral hemiplegia or monoplegia as the main feature. A systolic bruit is often heard at the carotid bifurcation.

Patients with subclavian steal syndrome can often hear a vascular systolic murmur in the subclavian fossa, decrease in blood pressure in the affected upper limb, weakened or difficult to palpate radial artery pulse, and may be accompanied by symptoms of vertebrobasilar artery insufficiency or carotid artery insufficiency. Innominate artery steal syndrome often presents with symptoms of both cerebral hemispheric and vertebrobasilar artery insufficiency.

Diagnostic Methods

Based on the above clinical manifestations, the diagnosis can be roughly established. Oculoplethysmography (OPG) can measure ophthalmic artery pressure, observe arterial waveforms and detect the time difference between blood flow reaching the eyeball and the ear shell. Carotid phonoangiography (CPA) and duplex scan can observe carotid artery lumen stenosis and blood flow. Bidirectional Doppler blood flow meter can determine the direction of supraorbital artery blood flow. Computer scanners, computer vascular diagnostic instruments and digital subtraction angiography are very helpful for diagnosis.

However, if surgery or interventional treatment is required, arteriography is still necessary to further clarify the location, extent and collateral circulation of the lesion. Seldinger puncture and selective cannulation through the femoral artery allows the insertion of a suitable catheter selectively into the aortic arch or common carotid or vertebral artery, injection of contrast agent with a high-pressure syringe and continuous radiography. Subtraction can eliminate bony structures and make the details of arterial lesions clearer. The diagnosis can be established when the bifurcation of the common carotid artery and its adjacent recurrent canal are severely narrowed, or there is a niche without obvious stenosis, or both, or when the common carotid artery and the origin of the subclavian artery or the innominate artery are blocked. Vertebral artery blood reflux can be confirmed by delayed radiography.

The following diseases should be excluded during diagnosis: Takayasu's disease, fibromuscular dysplasia, carotid artery aneurysm, and carotid artery torsion.