From this article you will learn: how and why there is a development of atherosclerosis of cerebral vessels, the manifestations and consequences of pathology, what methods of treatment exist, and how effective they are.
The essence and stages of the disease
Atherosclerosis of vessels in the brain - narrowing or clogging of cholesterol plaques of arterial vessels that bring blood to the brain. The result of such changes is deterioration of blood supply to the brain, a violation of its normal structure and loss of functions. In 85-90% of cases, people older than 45-50 years are ill.
Symptoms and consequences due to atherosclerosis of the brain vessels, ranging from periodic dizziness and memory loss, to stroke( necrosis of a part of the brain tissue) with severe disability of the patients( paralysis, loss of walking ability and elementary self-s
The disease develops gradually over several months or even years. In 80-90% of patients the first manifestations of atherosclerosis of the cerebral arteries do not disturb the general state and habitual way of life. If, after their appearance, to consult a specialist, the progression of the disease and irreversible disorders of cerebral circulation( stroke) can be prevented. Treatment medication, lifelong in the form of periodic courses 2-3 times a year. In 20-30% of cases, surgery is required.
Is engaged in treatment of a neurologist. If necessary, surgical treatment involves a vascular or endovascular neurosurgeon. Complete recovery is impossible, prevent the progression of pathological changes in blood vessels and normalize the cerebral blood flow can.
Essence, stages of the disease
Atherosclerosis of the cerebral vessels is a chronic disease, which is based on the defeat of the vascular wall with cholesterol plaques - excessive deposits of cholesterol in the form of nodules. These plaques protrude into the lumen of the vessel, causing narrowing of the lumen, loss of strength and elasticity of the wall. The disease affects only the arteries - vessels carrying blood enriched with oxygen and nutrients to the brain.
Pathological changes in the cerebral arteries in atherosclerosis occur in several stages and are prone to gradual progression:
- Excessive amount of cholesterol( atherogenic fats, lipids) in the blood - hypercholesterolemia, hyperlipidemia.
- Impregnation of the inner walls of the brain arteries with cholesterol inclusions, their accumulation in the form of nodules, plaques.
- Inflammation in the vascular wall, formation of dense scars, increase in the size of cholesterol plaques, transformation into atherosclerotic.
- Calcium deposition on the surface of plaques, their rupture, which causes the formation of thrombi.
- Narrowing or obliteration( complete overlap) of arterial lumen with plaques and thrombi, reduced strength, risk of spontaneous rupture of the vessel.
- Decreased flow of arterial blood, impaired blood circulation or necrosis( stroke) of the brain.
Causes of development and risk factors
Atherosclerosis of cerebral vessels has only one immediate cause of development - high blood cholesterol and other atherogenic fats( low-density lipoproteins, triglycerides). Such an exchange violation can occur only in a limited number of people( about 30-40%).Individuals with an increased risk of developing the disease are called a risk group:
- is more than 45 years old;
- hypertension( high blood pressure);
- presence of cerebrovascular atherosclerosis in close relatives;
- diabetes mellitus;
- systematic alcohol abuse;
- is a sedentary lifestyle;
- increased blood clotting( blood thickening).
At 50-60% of patients, atherosclerosis of the cerebral arteries is combined with a similar lesion of vessels of other localization( coronary arteries of the heart, aorta, lower extremities, kidneys, intestines).Therefore, the characteristic complaints and symptoms from the nervous system in combination with atherosclerosis of the vessels of any localization should be alarming regarding atherosclerotic lesions of the cerebral arteries.
Symptoms and consequences of cerebral atherosclerosis
By itself, the atherosclerosis of the vessels in the brain is not dangerous and does not manifest itself. Danger and negative symptoms cause diseases and disorders of cerebral circulation, which atherosclerosis provokes.
Manifestations and signs of cerebrovascular atherosclerosis can be acute( first arising) and chronic( observed for several months, years).The types and manifestations of this pathology are listed in the table:
|Diseases||Manifestations and symptoms|
|Acute: Transient ischemic attack, ischemic stroke, hemorrhagic stroke||Severe headache|
|Loss of consciousness or speech|
|Hand and leg paralysis on one side|
|Critical worsening of general condition, life-threatening|
|Chronic: dyscirculatory encephalopathy, cerebral artery aneurysm, dementia||Frequent or persistent aching headacheoli|
|Noise in the ears, movement coordination disorder|
|Walking dizziness, dizziness|
|Weakness and numbness of the extremities|
|Toughened or slurred speech|
|Memory and intellect reduction|
Features of the disease,on which the symptoms of
depend In 25-30% of patients atherosclerosis can develop for 10-15 years without causing disturbances of cerebral circulation, while in such patients all aresThe theories are affected to a different degree by the atherosclerotic process. In 15-20% of patients, after a few months or years, there are severe circulatory disorders in the brain, leading to disability, when the pathological process affects only one artery.
Symptoms of arterial atherosclerosis and the time of their onset depend on such factors:
- The level of increase in cholesterol level - the higher it is, the faster the progression of atherosclerosis.
- The lifetime of excess cholesterol for more than 5 years - the risk of cerebral atherosclerosis is increased by 50-60%.
- Individual features of the branching of the cerebral arteries and their diameter. For example, if they have a main type( several arteries are responsible for all blood supply), or move away from each other at a right angle - the progression of atherosclerosis is rapid, and cerebral circulation disorders are early and severe.
- The absence of connections between the carotid and vertebral arterial systems of the brain - the separation of the Willis circle, the absence of collaterals. This increases the risk of severe and early cerebral circulatory disorders by 60-70%.
- Which arteries are affected - each vessel is responsible for the flow of blood to a certain area of the brain: the anterior cerebral artery to the frontal lobe, the middle one - the parietal-temporal, the posterior to the occipital and cerebellum. The most common( 55-65%) is affected by the basin of the middle cerebral artery.
Reliable diagnostic methods for
Suspicion of atherosclerosis of cerebral vessels should be either confirmed or disproved. For this, laboratory tests( blood tests) and instrumental( hardware testing) diagnostics are used:
- Biochemical analysis of the lipid spectrum of the blood: cholesterol, triglycerides, LDL( low density lipoproteins).For this you need to donate blood from the vein. The analysis does not confirm the diagnosis of atherosclerosis, but only determines if a person is at risk of this disease: whether the rates are exceeded for at least one of these indicators. In 50% of patients with obvious symptoms of atherosclerosis, the studied parameters are within the normal range.
- US-Doppler, duplex scanning of cerebral vessels. The method is the most informative for studying only large cerebral arteries.
- Angiography of the arteries of the brain - the introduction of a contrast agent directly into the arterial system of the neck. Each large and small vessel is contrasted and becomes visible on the X-ray film, X-ray monitor. This is the most reliable method in the diagnosis of atherosclerosis.
- Tomography of the brain( CT or MRI) with intravenous injection of contrast medium is a good, fast and reliable diagnostic method that shows the state of all cerebral vessels.
Complex of therapeutic measures for arterial atherosclerosis of the brain:
- diet food;
- medication correction of cholesterol metabolism;
- decrease in blood viscosity;
- improved blood supply to the brain;
- correction of blood pressure;
- surgical operations.
Treatment should be lifelong in the form of alternating courses of therapy with these or other types of drugs 2-3 times a year. Since atherosclerosis is a background disease, a precursor of cerebral circulation disorders, the main goal of therapy is not so much to cure it completely, as to prevent progression and complications. Complete recovery is possible only at the stage of initial changes.
1. Dietary food
Restricting the amount of cholesterol used with food can reduce its concentration in the blood. At an atherosclerosis of vessels of a brain fats of an animal origin, fried dishes, smoked products are forbidden. The basis of the diet - products containing omega-3 fatty acids( vegetables and fruits, fish, flax and olive oil, nuts).
2. Medical correction of cholesterol metabolism
To reduce the concentration of cholesterol, drugs are used:
- Antiques: Simvastatin, Lovastatin, Atorvastatin, Atoris. It has been scientifically proven that systematic administration reliably( by 40%) reduces the risk of ischemic stroke and other disorders of cerebral circulation. It is enough to apply the drug once a day.
- Omega-3 fatty acids - the most powerful substance of natural origin against any arteriosclerosis of the vessels, including the arteries of the brain. It is best to replenish the supply of omega-3 food( linseed oil, yellow fish, nuts).Drugs and biologically active additives are also produced.
- Vitamin E( tocopherol).In itself, it has a weak effect against atherosclerosis, but in combination with other agents its therapeutic effects improve.
3. Blood thinning
Any stage of cerebral atherosclerosis is an indication for taking a blood-thinning medication:
- Acetylsalicylic acid, Aspirin, Cardiomagnolo, Magnikor, Lospirin;
- Clopidogrel, Trombone, Plavix, Plagril;
- Warfarin, Cincumar. More suitable in patients with severe symptoms of cerebral atherosclerosis, complicated by any type of cerebral circulation disorders.
4. Brain nutrition improvement
Drugs of this group do not affect the course of atherosclerosis of cerebral vessels, but allow nerve cells not to lose their function against circulatory disturbances:
- Normalizers of microcirculation: Cavinton, Trental, Cerebrolysin, Plestazol;
- Cerebroprotectors: Cinnarizine, Fezam, Ceraxon, Sermion, Neuraxon;
- Nootropics: Thiocetam, Nootropil, Pyracetam, Cortexin.
5. Control of blood pressure
Gradual normalization of high blood pressure and maintaining it at a normal level( no higher than 140/90) slows down the aggravation of atherosclerotic changes in the brain vessels by 30-40%.For this, the reception of the corresponding antihypertensive agents is indicated: bisoprolol, Berlipril, Lipraside, Valsacor. They are appointed by a doctor-therapist or cardiologist.
6. Operative treatment: indications and efficacy of
In atherosclerosis of the brain arteries, two types of operations on vessels are performed: endovascular( through puncture) and open( through the incision).Indications for surgical treatment are limited or small( up to 1 cm) narrowing of more than 50% of 1 to 3 main cerebral vessels. With uniform multiple lesions of the arteries, the operation is impractical. Indications occur in 45% of patients. They can be determined only after angiography or tomography of the brain.
Endovascular interventions are a truly effective method of preventing the effects of advanced atherosclerosis( ischemic stroke).
The essence of the operation: a puncture of the artery on the thigh or shoulder, the introduction into the lumen of a thin catheter, which under the control of computer equipment is carried out to the narrowed vessel of the brain. In this area, a stent( spring) is installed, eliminating the constriction.
Open interventions on vessels located in the cranial cavity are technically not feasible. So you can eliminate atherosclerotic plaques on the carotid arteries of the neck. Use either direct removal of ruptured plaques from the artery lumen( endarterectomy surgery), or replacement of the altered site with an artificial prosthesis( bypass surgery, vascular prosthetics).
Most probable prediction
Statistical data on cerebrovascular disease atherosclerosis are:
- In 50-60% of patients aged 40 to 55 years, the symptoms of the disease end with ischemic stroke due to a sharp narrowing of one large vessel. The consequences for 45 - 55% of them - a deep disability or death.
- About 80% of patients with cerebral atherosclerosis over age 65 suffer from chronic or transient impairments of cerebral circulation. In 30% of them subsequently there is a stroke.
- In 5-7% of people, the disease is asymptomatic and has no consequences.
These data indicate that the younger the symptoms of atherosclerosis appear, the worse the consequences and the worse the prognosis. If the problem is detected at an early stage, in 30-45% of cases it can be solved by endovascular surgical treatment. In people after 60 years, the narrowing of the vessels is of a loose character - in 80% of cases, medical treatment improves blood supply to the brain.