Atherosclerosis of the vessels of the brain
Author Ольга Кияница
- 1 Description of cerebral atherosclerosis of the cerebral vessels
- 2 Atherosclerosis of the cerebral vessels: symptoms
- 3 Medicinal treatment of atherosclerosis of the vessels of the brain
- 4 Surgical treatment of cerebral atherosclerosis
- 5 People's treatment of atherosclerosis in the cerebral vessels
- 6 Diet for atherosclerosis of the cerebral vessels
- 7 Prevention of atherosclerosis in the cerebral vessels
- 8 Atherosclerosis of the cerebral vessels: consequences
ead to further complications of the stroke type as it disturbs the blood flow through the intracranial arterioles.This leads to the fact that the lower parts of the brain, usually provided with a blocked artery, suffer from ischemia.
Atherosclerosis is a chronic, complex disease that afflicts half of women and two thirds of men after 40 years of age.[1 - Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics-2008 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation 2008; 117: e25-146.]
Diagnosis of the disease is usually done using visualization technology such as angiography or magnetic resonance imaging. The risk of cerebral atherosclerosis and related diseases, apparently, increases with age. Yet, there are many factors that can be controlled to prevent the development of the disease.
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Description of cerebral atherosclerosis of the cerebral vessels
Intracranial atherosclerotic disease is a progressive narrowing of the cerebral arteries inside the skull.
The blood, rich in oxygen, enters the brain through such blood vessels as sleepy and vertebral arteries. The Willis Circle is part of the vasculature at the base of the brain that connects these arteries. Atherosclerosis in most cases is determined in various parts of the carotid arteries, while, as indicated above, their narrowing arises due to the expansion of the atherosclerotic plaque.
Some of the main components of the plaques are connective tissue, extracellular matrix, including collagen, proteoglycans, fibronectin, and elastic fibers. Additionally, crystalline cholesterol, cholesterol esters and phospholipids, as well as cells derived from monocytes derived from macrophages, T lymphocytes and smooth muscle cells, can be determined.
Atherosclerosis of the brain vessels is the main cause of stroke in the world, with its share accounting for 30-50% and 10% of ischemic cerebrovascular events among Asians and whites, respectively [1 - Kim JS, Bonovich D. Research on intracranial atherosclerosis from the east and west : why are the results different? J Stroke 2014]
Stenosis (narrowing) of arterial walls with intracranial atherosclerotic disease develops in a manner similar to cardiac arteriosclerosis. At first, a plaque is formed inside the vessel, also known as atherosclerotic lesion, and in the future a plaque forms, the size of which may increase so much that the blood flow in the vessel completely overlaps.
ASGM can cause or contribute to the development of cognitive impairment. There are several mechanisms for their occurrence. In particular, thrombosis in situ, arterial embolism, hemodynamic compromise and atherosclerotic occlusion of small arterial branches may occur.
The most severe complications of ASGM are stroke, which in turn threatens a patient with a disability or a fatal outcome.
Atherosclerosis of the vessels of the brain: ICD
According to the International Classification of Diseases 10 revisions are the code for atherosclerosis I70. But from his description, cerebral atherosclerosis, which was assigned the code I67.2, was excluded. The description of this code also indicates the atheromy of the arteries of the brain.
Causes of atherosclerosis of the vessels of the brain
The risk factors for intracranial aterosclerotic disease are the same for all atherosclerotic pathologies that occur in other parts of the body, for example in cardiac vessels that cause heart attacks. Certain risk factors may increase the probability of atherosclerotic lesions of the carotid artery.
Some of these predisposing factors can not be corrected, while others change or are completely eliminated.
Risk factors that are not subject to change:
- Age over 40 years old.
- Gender (more women are predisposed).
- Unfavorable heredity.
- Presence of stroke and / or history of a heart attack.
- Race (often developed by people of Asian origin).
Risk factors that are subject to change or can be addressed:
- Arterial hypertension.
- Improper nutrition.
- Diabetes mellitus
- Cardiac pathologies (eg, heart attack, heart failure).
- Diseases of the arteries outside the heart and trunk vessels.
- Excess weight of the body.
- Excess of cholesterol in the blood.
- Lack of physical activity.
Atherosclerosis of the cerebral vessels: symptoms
Unfortunately, unlike carotid artery atherosclerosis, which often causes transient ischemic attacks (TIA or mini strokes), cerebral vascular arteriosclerosis is often found only with severe damage to the arteries.
Common signs and symptoms of stroke or TIA may occur suddenly:
- Feeling of numbness or weakness in the face, arms or legs, especially on the one hand.
- Confusion or dizziness.
- Violation of speech or consideration.
- Disorder of vision in one or both eyes.
- Change in walking, loss of balance or coordination.
- Strong headache without any known cause.
- Problems with swallowing.
In addition, the patient may experience sudden loss of consciousness or convulsions.
If these symptoms were noticed by a person or a close friend, you should seek immediate medical attention. The patient should be taken as soon as possible to the hospital in order to have certain types of treatment performed.
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Diagnosis of cerebral vascular arteriosclerosis
At the doctor's examination, the doctor ascertains all the complaints from the patient or people close to him, after which an objective examination and auscultation are performed. In the future, in order to clarify the diagnosis, appropriate diagnostic methods must be performed, including:
- MRI angiography.
- Computer tomography.
- Occupational test.
- Transcranial Doppler.
- Transcranial Sonography.
The choice of examination depends on the indications and the condition of the patient.
Because of the positive remodeling, the accumulation of plaques, shown on the angiogram, may appear further along the x-ray beam, where the diameter of the lumen will look normal, even if there is a severe narrowing on the real area.Since angiography is performed using X-rays, the number of times a person can undergo this study throughout the year is limited by guidance on the amount of radiation that can be exposed within one year.
- MRI angiography of vessels
To the site above the aorta, 20 ml of gadolinium is introduced for contrast, after which they take pictures of the MRI apparatus and evaluate the condition of the vascular bed of the brain.
- Magnetic resonance imaging (MRI)
Magnetic resonance imaging allows quantitatively to determine the anatomy and composition of the atherosclerotic sediment. This allows physicians to determine the qualitative characteristics of the pathological attack, for example, the likelihood that it can break away from the wall of the vessel and become embolus. During MRI, ionizing radiation is not used, so the amount of exposure per person is not limited. However, since MRIs use strong electric fields, those who have metal implants can not undergo such a diagnosis.
- Computer tomography
Multi-directional computed tomography (MNC) is better than conventional CT because it can provide higher spatial resolution and is performed in a shorter time. The MNC uses X-rays to obtain an image; further research can help identify the composition of the atherosclerotic plaque. Thus, it can be determined whether the attack is calcined and rich in lipids, and what are the risks of its occurrence. In this procedure, the test subjects are exposed to significant radiation exposure, so the use of CT is limited.
- Occupational test
It is carried out using a special air cylinder. The doctor inflates the balloon inside the affected artery to completely block the bloodstream, and then checks the work of the brain. This helps to determine the effect of blockage on cerebral circulation.
- Transcranial Doppler ultrasound (TC ultrasound)
Above the head is a probe that generates high-frequency sound waves. Changing these waves can help to see the direction and speed of blood flow in the brain.
- Transcranial sonography with color coding
This ultrasound test is similar to TC ultrasound, but blood flow in the brain has color coding.
Medicinal treatment of atherosclerosis of the vessels of the brain
In an asymptomatic course of an intracranial stenosis, the initially prescribed platelet inhibitors such as aspirin. The purpose of treatment in this case is to stop the accumulation of atherosclerotic plaque. A person does not make any complaints, however, if the disease progresses, the symptoms will most likely be manifested.
Patients with symptomatic manifestations are prescribed anticoagulant drugs. In such cases, it is necessary to try to reduce the number of stents. Anticoagulants reduce the likelihood of further accumulation, and also try to destroy accumulated plaques on the surface without formation of embolism.
When determining a patient with severe stenosis, an unavoidable stroke is threatened, and in such cases, endovascular treatment is used. Depending on the patient's specifics and stenosis, appropriate procedures may be undertaken. In particular, angioplasty, endovascular stenting or bypass grafting of the blocked portion of the vessel.
Basic treatment strategies:
- Intracranial stenosis is primarily treated with drugs that minimize risk factors, including high levels of cholesterol and blood pressure.
- If the patient smokes, the means to help get rid of this bad habit can be used.
- In the presence of diabetes mellitus, it is often recommended to strictly control blood glucose levels with the help of rational nutrition and proper lifestyle
Blood diluents , also called anticoagulants (aspirin, plavix, kumadin), promote blood circulation through narrowed arteries and prevent intravascular coagulation. Studies show that aspirin and kumadin act in the same way on the body.Since blood diluents contribute to the development of bleeding, patients should undergo careful monitoring of blood coagulation.
Aspirin has less side effects than kumadin, and is associated with a lower risk of bleeding or hemorrhage (including in the brain). If for the appointment is prescribed kumadin, the patient should periodically check the coagulability of the blood; At the same time during the reception of aspirin and / or plavix, monitoring is not necessary.
Drugs that lower cholesterol contribute to the inhibition of the formation of atherosclerotic plaques. These drugs reduce the amount of LDL cholesterol (low density lipoprotein) on average by 25-30%. Particularly effective in combination with low-fat and low-cholesterol diet.
Drugs for the treatment of blood pressure such as diuretics, ACE inhibitors, angiotensin blockers, beta-blockers, calcium channel blockers help keep the pressure within the normal range. Since its elevation is a major risk factor for stroke, it is recommended that regular blood pressure measurements be taken and timely medications taken.
Surgical treatment of cerebral atherosclerosis
The main purpose of the operation is to prevent stroke. To do this is to remove or reduce the formation of atherosclerotic plaque and the expansion of the arteries, which provides a greater inflow of blood to the brain. Surgical treatment is considered in those cases where the symptoms do not succumb
medical stopping. For example, an indication to the operation is:
- Repeated TIA or stroke.
- Determination of high degree of stenosis.
- There is insufficient blood supply to any part of the brain.
Balloon angioplasty / stenting is a minimally invasive endovascular procedure in which the plaque is squeezed and the diameter of the artery expands. Endovascular intervention means that the procedure is performed inside the vessel with the help of a flexible catheter. The catheter is injected into the femoral artery under the control of angiography. Then the catheter moves along the blood flow system to where the narrowed artery with a plaque is located.
The main purpose of the procedure is to reduce stenosis by less than 50%, resulting in a slight increase in the diameter of the vessel contributing to an improvement in blood flow to the brain.
In the right place, the small balloon is slowly inflating, it expands and compresses pathological formation, located on the wall of the artery. Then the balloon is lowered and removed. After the balloon is removed, a self-expandable mesh tube, called a stent, is placed in the plaque area. She holds the artery in a constantly open position. The stent remains in the arteries permanently.
Complications after angioplasty can include:
- breakthrough of the vessel wall by a catheter or cylinder;
- vascular spasm
Angioplasty is most often performed with severe arterial stenosis (over 70%) and a recurrent TIA or stroke, which is not corrected by medical treatment. Angioplasty / stenting can successfully reduce stenosis to less than 30% without complications in 60-80% of patients.
The cerebral arterial bypass is a surgical intervention by which the blood supply is directed around the portion of the vessel with the plaque. During the operation, make a hole in the skull, called craniotomy. The scalp is taken from a donor vessel, which is separated from its normal position at one end, redirected to the inside of the skull and connects to the artery on the surface of the brain. Now the scalp artery supplies the brain with blood bypassing the blocked vessel.
Complications following a bypass may include:
- spasm of blood vessels;
- blood coagulation in a donor vessel.
The bypass path is usually recommended when the artery is blocked by 100% and angioplasty is not possible. The results of arterial bypassing vary widely depending on the place and type of operation.
Video: Brain Bypass Procedure
Upon returning home after the hospital, you must necessarily follow the advice of your surgeon or cardiologist regarding the return to normal livelihoods. It is also important to take care of the cutaneous site and to monitor any signs of infection, such as fever, chills, unusual pain, bleeding or swelling at the cutoff site. If you have been prescribed medication to prevent the formation of thrombotic clots, you should take it in accordance with the medical instructions.
You need to be careful if you have been given a brain shunt and after the operation you have to wear glasses. If the glasses are too close to the temple area, the graft may be damaged. To prevent this, you need to protect the damaged place with a gauze swab.
After stenting or surgery, it is important to adhere to all scheduled follow-up visits to the doctor. It may also be necessary to periodically examine or pass the tests so that the doctor can monitor the health status.
People's treatment of atherosclerosis in the cerebral vessels
There are various plants used in folk medicine that help to reduce the severity or prevent the development of atherosclerosis. In the brain, not all substances come in, because the hematoencephalic barrier is activated, but a number of agents may still be useful in ASGM.
Garlic contains allicin, which has been found to lower cholesterol LDL. Garlic can also reduce the level of triglycerides in the body by 20%. Lowering the level of triglycerides also stops the formation of plaques inside the blood vessels.
Garlic has the ability to stop the oxidation of cells in the arteries, so they do not suffer from damage. Certain compounds in the plant can also dissolve blood clots.
This magic powder of southeastern origin contains curcumin. It is eight times stronger than vitamin E against oxidation.Its use prevents damage to the walls of the vessels, strengthens them and improves blood circulation in the arteries.Turmeric was used in Indian medicine to treat wounds, but it can also lower cholesterol, lipids and slow the formation of blood clots.
Greenery always works well on the body. Even the green itself has a calming effect on the eyes. Spinach, however, is very useful for the health of the heart and blood vessels. This is a very nutritious vegetable that can lower blood pressure. It contains selenium, beta-carotene and manganese that fight with atherosclerosis. It also defines neoxanthin and violaxanthin, which are anti-inflammatory compounds that support the health of blood vessels, preventing inflammation of their walls.
To make sure that the heart and blood vessels are healthy, function properly, some changes in lifestyle, such as refusal from fast food and adherence to rules of a more natural diet, need to be made. Beans are really useful for humans. They contain a lot of nutrients and do not have harmful fats in their composition. If you learn to cook beans correctly, they can be very tasty and full of food.
Most legumes have a rich potassium content, which can lower blood pressure. This happens by expanding the blood vessels, which results in lowering the load on the entire cardiovascular system.
If the vessels of the brain are in a dangerous condition, it is recommended to avoid eating meat as much as possible.The reason is that proteins and other nutrients contained in these products can easily destroy the cells of the body.While eating meat is too much of a problem for the body, salmon is a very good way to strengthen your health. This variety of fish has a good balance of HDL cholesterol and LDL with a wide range of minerals such as potassium, selenium, choline and pantothenic acid, which are beneficial to humans.
Potassium contained in fish can reduce the burden on the cardiovascular system, contribute to the relaxation of blood vessels, therefore it is also called vasodilator. Only need to be careful with the content of mercury in the fish, which in a certain amount leads to side effects.
- Fish fat
Many people mistakenly believe that all the fats are bad, which is not entirely correct. The human body needs certain types of fatty substances that guarantee that all organs and systems can work well. In particular, there is a need for a certain balance between omega-3 fatty acids.
Fish fat contains a high concentration of omega-3 fatty acids, which can balance the level of cholesterol in the cardiovascular system. It also prevents the accumulation of cholesterol plaque in blood vessels, which is the main cause of atherosclerosis. In addition, the likelihood of blood clots, stroke, or heart attack is reduced.
Ginger is a very powerful spice against high levels of LDL cholesterol, thick blood and aggregation of platelets. This vegetable also reduces blood pressure and prevents loss of elasticity of vessels. To improve blood circulation, it is highly desirable to include it in the diet.
- Green tea
Green tea has various health benefits. Among them is its antioxidant power. It prevents damage of arterial cells by free radicals. Also contained in it polyphenols prevent the penetration of cholesterol through the intestinal wall.
This berry has strong antioxidant properties that protect the vessels from the formation of cholesterol plaque. It can also contribute to lowering high blood pressure and normalizing cholesterol levels. As a result, the vessels become stronger, so the hawthorn is a good way to fight atherosclerosis.
Diet for atherosclerosis of the cerebral vessels
A healthy diet lowers LDL cholesterol and triglycerides. It consists of:
- Different products with low fat and cholesterol and high fiber content.
- Lots of fruits and vegetables.
- Limited sodium.
The fat should be no more than 30%, and saturated fat - no more than 8-10% of the total daily caloric content, according to the American Cardiology Association.
The level of cholesterol should be limited to about 300 milligrams per day, and sodium (salt) to about 2400 milligrams.
Exemplary daily diet formula:
- 6-11 servings of bread, flakes, rice and pasta;
- 3-5 servings of vegetables;
- 2-4 servings of fruit;
- 2-3 servings of milk, yogurt and cheese;
- 2-3 servings of meat, poultry, fish, dry beans, eggs and nuts.
Fats, oils and sweets should be used with caution. Monounsaturated oils such as olive and rapeseed (canola) are a good alternative to cooking.
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Prevention of atherosclerosis in the cerebral vessels
A healthy lifestyle - proper nutrition, regular exercise, healthy weight maintenance, smoking cessation and hypertension control - can reduce the risk of developing atherosclerosis, help prevent progression of the disease, and sometimes cause its regression. In addition to the organization of proper nutrition, other recommendations should be followed:
- Regularly do physical exercises . Aerobic exercise can lower blood pressure, help control weight and increase cholesterol levels of HDL ("good" cholesterol). Also, the blood vessels will be more flexible. According to the Centers for Disease Control and Prevention and the American College of Sports Medicine, moderate or intensive aerobic exercises lasting about 30 minutes (or three times for 10 minutes of exercises) are recommended four or more times a week. Aerobic exercises include walking, jogging and cycling, active gardening, climbing stairs, or bustling homework. Before training, you should consult a doctor if there is atherosclerosis or the patient is at increased risk of stroke or myocardial infarction.
- Maintaining the desired body mass . Losing weight can help lower total cholesterol and LDL cholesterol, lower triglycerides, and increase cholesterol levels of HDL. With the normalization of weight also decreases arterial pressure. Proper nutrition and physical exercise are two key components in maintaining the desired body weight.
- You do not have to smoke and drink toxic substances . Smoking has a lot of harmful effects on the heart, but refusing cigarettes can correct the situation. Former smokers over the course of five to ten years after the cessation of smoking face the same risk of cardiovascular disease, which is non-smokers at all. Smoking is the worst that a person can do with his heart and lungs.
- Conduct treatment for hypertension . Elevated blood pressure can be controlled by changes in lifestyle, proper nutrition, exercise, stress management, smoking cessation and alcohol use. It is also necessary to take medications prescribed by the doctor. Hypertension usually has no symptoms, therefore, it is necessary to regularly measure arterial pressure. Like cholesterol, hypertension is called "silent killer".
Atherosclerosis of the cerebral vessels: consequences
Diseases associated with cerebral atherosclerosis can be seriously detrimental to the health of the patient. At the current course of atherosclerosis of the cerebral vessels, hypertonic arteriopathy, Alzheimer's disease, stroke may occur.
- Hypertensive arteriopathy
This pathological process is a thickening and damage to the walls of the arterioles. With its development, the ends of arterioles, which are located in deep gray nuclei and deep white matter of the brain, are mainly affected. It is believed that this is what causes cerebral changes in the deep areas of the brain. Similar damage to small vessels may also reduce amyloid clearance, thereby increasing the likelihood of even more severe consequences.
- Alzheimer's Disease
Alzheimer's Disease is a form of dementia that entails brain atrophy. Cerebral amyloid angiopathy is detected in 90% of cases at autopsy, and 25% is a severe form of the disease.
Stroke arises due to a sudden loss of blood flow in any part of the brain. Blood flow disturbances usually occur due to blockage or hemorrhage. Studies of post-mortem stroke have shown that intracranial growth of atherosclerotic plaques occurred in more than half of the individuals, and more than one third of all cases had an increase in stenosis.
Atherosclerosis is a long-lasting disease, which at first almost never manifests itself. Atherosclerosis of the brain vessels is one of the forms of this disease, and in severe cases it can be complicated by a stroke or other complicated pathologies.
To diagnose the disease, both laboratory analyzes and instrumental diagnostic methods are used. In the treatment of atherosclerosis is important as a change in lifestyle, physical activity, and the reception of appropriate drugs. If necessary, national methods of exposure may be used, and, in extreme cases, surgical intervention is performed.
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