Asymptomatic carotid bifurcation stenosis with noise
The cause and source of origin of the noise, listening at the carotid bifurcation atherosclerotic lesions (place of further division of the common carotid artery at its inner and outer branches) have not yet led to the emergence of transient ischemic attack (TIA microstroke) or stroke, the brain is unknown. According to publications, research conducted in small populations were analyzed, and most of them failed to establish the localization and degree of stenosis (narrowing of the lumen of the artery), carotid bifurcation.
Examination of patients with asymptomatic carotid stenosis and cervical noise directed to the extensive vascular surgery, characterized by similar shortcomings. In most studies noted that patients with cervical noise increased risk of heart disease, stroke and death. Meanwhile, a stroke (cerebral infarction) need not be developed in the basin of the vessel from which the noise. Given this, perform operations on the carotid artery in patients with asymptomatic stenosis of her (narrowing of the internal lumen of the artery) is not always appropriate.
However, in patients with gross stenosing lesions at the beginning of the internal carotid artery (when only 1.5 mm or less from the initial lumen when it is narrowing), which reduces blood flow to the brain in the distal (overlying) sections of the internal carotid artery, an increased risk of thrombotic occlusion (blockage of the lumen of the artery).
Although these patients, a decrease of blood flow in the upper part of the internal carotid artery lesion remains asymptomatic because they have an adequate ipsilateral (opposite side), blood flow through the front of the circle of Willis in the ipsilateral middle and anterior cerebral artery. Therefore, stroke (cerebral infarction) may develop later in connection with arterioarterialnymi embolism. The noise associated stenosis (narrowing of the lumen) at the beginning of the internal carotid artery, high -sounding and long, often listening and auscultation during diastole. As the progression of stenosis of the vessel supplying the brain, and slowing of blood flow in it is reduced and noise upon the occurrence of occlusion (complete blockage of the lumen of the artery) disappears.
Non-invasive study of carotid arteries, which include the B- scan, ultrasound Doppler blood flow study (USDG) immediately distal to (above) the site of stenosis (narrowing) of the lumen of the vessel, the quantitative spectral analysis of noise and determination of oculo-systolic pressure by okulopletizmografii, allow us to identify sites expressed stenosis.
No study of the efficacy data endarterectomy surgery compared with antiagregatsionnoy therapy (aspirin, trental, etc.) in asymptomatic carotid stenosis, bifurcation, so the physician can choose either method of treating a patient. Most often stenosis (narrowing of the lumen) at the carotid bifurcation prescribe antiplatelet agents (aspirin, trental, etc.). If signs of progressive narrowing documented (ultrasonic Doppler, CT angiography, MR angiography) and the diameter of the residual (remaining) lumen (artery) is 1.5 mm or less from the initial lumen narrowing when, the treatment of choice for patients considered surgery - operation endarterectomy.
The frequency of complications surgery Endarterectomy should not exceed 2 %. However, there is no evidence that surgical treatment of patients with asymptomatic stenosis of the cervical and noise efficient conservative treatment, and therefore the need for further statistics.