Atherosclerotic lesions of the vessels of the neck and head
Ischemia is the lack of blood supply to an area of the brain due to obstruction of the inflow of arterial blood.
Stroke (Latin insultus) is an acute cerebrovascular accident (ACVA) characterized by a sudden loss of neurological function (within several minutes, hours), which can last for more than 24 hours or lead to death earlier.
Ischemic stroke is an acute cerebral circulation disorder caused by thrombotic or embolic occlusion of an artery, resulting in a subsequent brain tissue damage and loss of its function.
Ischemic stroke occurs 4 times more often than hemorrhage, ranking first in the structure of vascular diseases of the brain, with an average of 400-500 cases per 100,000 population a year.
Every year, 4.5 million people in the world die from stroke. Mortality rate due to ischemic stroke is 12–20% of the total mortality, second only to deaths from heart diseases and all cancers.
Pathogenetic scheme of ischemic stroke
Core (“ischemic core”) or zone of irreversible injury is formed within 5-8 minutes after ACVA.
Penumbra (“ischemic penumbra”) is a zone of potentially salvageable ischemic damage, with lower level of blood flow, but with energy metabolism and some functional, but not structural changes. The duration of the penumbra is of great importance, as in the course of time reversible changes become irreversible.
Oligemia is an area of hypoperfusion, vitalized tissues without treatment.
Treatment of ischemic stroke is the most effective in the period of “therapeutic window”, that is within the first 3-6 hours after its first symptoms.
In case of any ischemic conditions, which might be the beginning of ischemic stroke, it is crucially important to seek medical treatment as soon as possible.
Risk factors for ischemic stroke
|Non-modifiable risk factors||Modifiable risk factors|
With the increase in the number of risk factors and with their simultaneous combination, the risk of stroke increases by 2-3-5 times or more.
The success in controlling ischemic stroke involves early examination and treatment of any ischemic conditions, particularly with regard to the patients who are at risk.
Ischemic stroke symptoms
- numbness and asymmetry of the face
- numbness or movement disorder of the limbs
- speech disturbance, difficulty articulating, wrong use of words (“word salad”)
- sudden headache
- trouble seeing
- difficulty remembering and orienting
- alteration of consciousness
- coordination dysfunction
- cerebral seizures
- loss of other functions depending on the brain tissues
The above symptoms may be during several hours and disappear in the course of treatment or without it. If these manifestations regressed within 24 hours, transient ischemic attack (TIA) must be considered. BUT!!!TIA is believed to be a warning sign for ischemic stroke, which requires urgent specialized examination and treatment.
- Clinical laboratory tests to the fullest extent possible with obligatory coagulation test, blood glucose test, determination of ionic composition, nitrogen metabolism.
- USDG of the vessels of the head and neck to determine constrictive and occlusive lesions, atheromatous plaque characteristics, the level and degree of vascular narrowing.
- CT, MRI of the brain with angiography as the circumstances require.
- Perfusion CT (PCT) with hemodynamics characteristics at the capillary level.
- Endovascular cerebral angiography for detailed characteristics of the vessels of the head and neck taking into account the peculiarities of the pathology, the presence of anastomoses, and the choice of endovascular treatment.
The main cause of ischemic stroke (of non-cardiac genesis) is stenosis (narrowing) and obstruction (occlusion) of the vessels supplying the brain.
Stenoses are caused by atherosclerotic plaques and can affect the neck vessels (extracranial stenoses) i.e. stenoses of the carotid and vertebral arteries. In case of atherosclerotic narrowing of cerebral vessels located in the cranial cavity (intracranial stenoses), stenosis of the middle cerebral artery, basilar artery is most common. This lesion is systemic and may be accompanied by different degrees of narrowing of two or more arteries supplying the brain.
Methods of treatment of ischemic stroke
Extracranial stenting and angioplasty
Patient B., 53 years old. Critical stenosis of the left internal carotid artery (ICA). A – before the surgery, B – after angioplasty with stenting of the left ICA.
Patient B., 57 years old. Critical stenosis of the left internal carotid artery (ICA). A – before the surgery, B – after angioplasty with stenting of the left ICA.
Patient K., 66 years old. Critical stenosis of the right internal carotid artery (ICA). A – before the surgery, B – after angioplasty with stenting of the right ICA.
Patient B., 65 years old. Critical stenosis of the right vertebral artery. A – before the surgery, B – after angioplasty with stenting of the right vertebral artery.
Intracranial stenting and angioplasty
Patient I., 79 years old. Subtotal stenosis of the left middle cerebral artery (MCA) A – before the surgery, B, C – Wingspan stent delivery at the level of stenosis of the left MCA; D, E – stent insertion; F – dilatation of stenosis of the left MCA.
Intracranial stenosis angioplasty
Patient M., 64 years old. Critical stenosis of the left middle cerebral artery (MCA, segment М1) А – introducing balloon dilation; B – balloon angioplasty; C – removal of stenosis of the left MCA.
Patient N., 58 years old. Thrombosis of the left middle cerebral artery (MCA). A – determination of thrombosis level (segment М1); B – recanalization to М1-М2 segments; C – control of regional vessels blood flow; D, E – thrombextraction; F – recanalization of the left MCA.
Patient K., 61 years old. Thrombosis of the left middle cerebral artery (MCA) in initial segments. A – determination of thrombosis level; B – stent retriever for thrombus removal; C – thrombextraction; D – recanalization of the left MCA; E – thrombotic masses after their removal from blood stream.