Patients who have had a stroke or are at high risk of stroke are first evaluated and followed up by neurologists. Your neurologist will have you perform some tests (Doppler USG, Brain-Neck CT-Angiography or MRI-Angiography). One of the most common causes of stroke is plaques in the carotid arteries (jugular vein). If the stenosis caused by these plaques is serious, it may disrupt the nutrition of the brain tissue on the same side and cause some complaints in the patient. Patients who are found to have serious stenosis in the carotid arteries are referred to a cardiovascular surgeon for further examination and treatment.

CAROTID ARTERY STENCINES: What is the Carotid Artery, Where Are They Located and Why Are They Important?

Brain tissue receives the clean blood it needs to perform its normal functions through four arteries. Two of these arteries, fed by the aortic arch, travel to the right of our neck, and the other two travel to the left, heading towards the brain (see the figure). Figure 1: Arteries responsible for feeding the brain SCA: subclavian arteries, VA: vertebral arteries, CCA: common carotid arteries ICA: internal carotid arteries, ECA: external carotid arteries i. Internal carotid arteries (ICA): - Internal carotid arteries are the main branches of the common carotid arteries (carotid arteries) (CCA) that feed the brain. -It enters the skull by traveling upwards from both front/sides of the neck. -Internal (internal) carotid arteries feed the front and middle parts of the brain hemisphere on the same side and the retina layer of the eye through the branches they give inside the skull. -Internal (internal) carotid arteries carry fresh blood to 70% of the brain tissue. -External carotid arteries (ECA) are the other main branch of the common carotid arteries and they give branches that feed the face, neck and scalp on the same side, but they have nothing to do with the nutrition of the brain tissue. ii. Vertebral arteries (VA): -Vertebral arteries are branches arising from the arm arteries (subclavian arteries, SCA) going to both arms, and enter the skull by traveling upwards from both back/sides of the neck. -Vertebral arteries supply the back parts of the brain, cerebellum and brainstem. -Vertebral arteries provide blood supply to 30% of the brain tissue. * At the base of the brain, internal carotid arteries and branches of the vertebral arteries form connections with each other (Willis polygon). Thanks to these connections, continuity of brain circulation is ensured in case of blockage in any vessel.

Why is it important to have plaque causing stenosis in the carotid arteries? 

The tolerance of brain tissue to lack of oxygen is so poor that brain cells that are left without oxygen for more than four minutes begin to die irreversibly. For this reason, stenosis or blockages in the carotid arteries that carry clean blood to our brain can lead to temporary or permanent neurological disorders in the relevant parts of the brain. * The presence of plaques in the carotid arteries puts the patient at risk of stroke. Because a clot that forms on a crack or tear in this cholesterol plaque can suddenly cut off the blood flow in the already narrowed vessel, causing the patient to have a stroke. (See the figure on the side).

How is the decision taken to intervene in stenoses in the carotid arteries?

There are three treatment methods for the treatment of patients with carotid stenosis: drug therapy, non-surgical (endovascular) treatment and surgical treatment (carotid endarterectomy).  Non-surgical and surgical treatment methods are complementary to each other rather than alternatives.  A board has been established in our hospital to assist patients with carotid artery stenosis in making decisions in the advanced diagnosis and treatment stages. This board, called "Yücelen Hospitals Heart Team", includes doctors from neurology, cardiovascular surgery, cardiology, anesthesia, internal medicine, pulmonology and occasionally radiology. With an approach focused on the patient, not the disease, the Heart Team evaluates all aspects of the patients brought to the board and offers the most appropriate and most beneficial treatment method to the patient by mutual decision in the light of national and international guidelines. In this way, it aims to help the patient make a decision regarding his own treatment.

What are taken into consideration when deciding on the treatment method to be recommended for a patient with carotid artery stenosis?

 The parameters taken into consideration when deciding on the type of treatment to be recommended in a patient with carotid artery stenosis are: The patient's complaints The degree of stenosis caused by the plaque in the patient's carotid artery. Additional medical problems of the patient (are there any problems that increase the risk of the planned intervention?) The course, structure, and stenosis of the patient's carotid artery. The width of the section after it, etc. features. The location and structure of the plaque causing the stenosis in the patient (whether it can be accessed by surgery, whether it is ulcerated, the degree of calcification, etc.) Whether the patient has accompanying coronary artery disease.

How is Carotid Stenosis Surgery (Carotid Endarterectomy) Performed?

Since atherosclerosis is a systemic disorder, patients with stenosis in their carotid arteries are likely to have stenosis in their coronary arteries. For this reason, all our patients who are scheduled for carotid endarterectomy surgery undergo detailed cardiological examination and, when necessary, coronary imaging before the surgery. In our hospital, surgeries for carotid stenosis are preferably performed under general anesthesia. During carotid endarterectomy surgery, patients' brain oxygenation levels are monitored instantly with a NIRS (Near Infrared Spectroscopy) monitor. The carotid artery is located through a small incision made in the neck area where the stenotic carotid artery is located. Following the administration of blood thinning medication (heparin), the carotid artery and its branches are clamped. Then, after an incision is made in the carotid artery where the stenosis is located, the plaque narrowing the vessel is removed and blood flow is restored. The surgery takes approximately 1-2 hours on average. Patients are usually awakened in the operating room and weaned off the ventilator. If the patient does not need intensive care due to additional medical problems, he is taken to the service after the surgery and discharged after 2-3 days. Points that Patients with Carotid Artery Stenosis Should Pay Attention to: Absolutely stopping smoking and tobacco use (regardless of the degree of stenosis) Regular exercise Healthy diet Weight control (patients are recommended to reduce their normal body mass index) Strict blood pressure monitoring (salt restriction and use of blood pressure medication if necessary) ) Strict sugar control (using diet and, if necessary, sugar-lowering drugs) Using diet/cholesterol medication to keep the LDL cholesterol (bad cholesterol) level below 100 mg/dl. Regular use of blood thinners recommended for the patient for a long time. The patient coming to the polyclinic for regular check-ups. What is Meant by Regular Exercise? Why? * According to AHA (American Heart Association) recommendations, what is meant by exercises that protect against cardiovascular diseases: a. 30 minutes of moderate intensity exercise 5 days a week (150 min/week) * Examples of moderate intensity exercises: - brisk walking - cycling (slower than 16 km per hour) - gardening - playing tennis (in pairs) - ballroom dances b. 25 minutes of vigorous exercise 3 days a week (75 minutes/week) * Examples of vigorous exercise: - climbing uphill or walking at a fast pace - cycling (faster than 16 km per hour) - running - doing heavy gardening (hoeing, digging, etc.) -playing tennis (single) -aerobic dance What is meant by Healthy Nutrition? * Foods consumed; It is meant to be rich in fruits, vegetables, whole grains, legumes and nuts, moderate in low-fat dairy products and seafood, and low in processed meat products, sweetened beverages, salt and processed grains.