Chronic Venous Insufficiency and Ulceration
Excessive Sweating (Hyperhidrosis)
Carotid Artery Disease
The
brain requires a constant supply of blood and oxygen; interruption of that
supply for more than just a few minutes usually results in permanent brain
damage i.e. a stroke
There are many different types and causes of stroke but probably the commonest results from furring up of the arteries in the neck that lead up to the brain.
There are four such arteries:
- Two carotid arteries that lie at the front of the neck and supply the front part of the brain and the eyes
- Two vertebral arteries that run up the back of the neck through the spine and supply the back of the brain
The carotid arteries are the more important because they carry more blood and because the front of the brain is responsible for some of our most important functions i.e. consciousness, movement, sensation and speech
The picture left shows an carotid angiogram (blood vessel x-ray) of a revealing a stenosis (narrowing) of the carotid artery, highlighted by the arrow.
The left side of the brain runs the right side of the body; and vice-versa. In
right handed people the left side of the brain (known as the left hemisphere) is
arguably the most important because it supplies the right hand. This, so-called
‘dominant’ hemisphere also usually controls speech. In left handed people
either the left or the right hemisphere can be dominant.
If there is a narrowing or blockage of the left carotid artery then this may result in a lack of blood supply to the:
- Left hemisphere (left front side of the brain) resulting in loss of sensation and paralysis down the right side of the body and, in a right handed person, loss of speech (i.e. a stroke)
- Left eye resulting in blindness
If the blockage lasts for only short period of time then the symptoms of the stroke may be temporary and then this is called a Transient Ischaemic Attack (TIA). The word ischaemic is the medical term for lack of blood supply. Similarly, the blindness can also be temporary; a condition known as Amaurosis Fugax.
The recognition of TIA and Amaurosis Fugax is important as affected persons are at high risk of going on to develop a full blown stroke and to go blind if the furring up in the carotid artery is not treated
All patients found to furring up of the carotid arteries should be started on Best Medical Therapy (BMT) comprising:
- Smoking cessation: complete and permanent
- Control of blood pressure
- Anti-platelet agent such as Aspirin 75mg daily
- Lipid lowering therapy with a statin such as Simvastatin 40mg daily at night
BMT will reduce the risks of furring up getting worse and the risks of stroke and blindness.
If the carotid artery is narrowed by more than 70% then the risk of stoke and blindness can be further reduced by up to a half by removing the furring up by means of an operation – called a carotid endarterectomy.
In the future, carotid artery disease may be treated by carotid stenting where a small metal tube (the stent) is placed into the artery to keep it open. The advantage of stenting over surgery is that the stent can be inserted into the carotid artery via the artery at the top of the leg thus avoiding any cuts in the neck. At present we do not know if carotid stenting is as effective as carotid endarterectomy at preventing strokes and blindness. However, studies are currently underway and it is possible that in 5-10 years time most patients with carotid artery disease will be treated by stenting rather than surgery