Long before a stroke occurs, the body may present warning signs that go unnoticed. Among them are changes in the carotid arteries, vessels located in the neck and responsible for taking blood rich in oxygen and nutrients from the heart to the brain.

According to Dr. Celso Ricardo Bregalda Neves, vascular surgeon and member of the Carotid Diseases Committee of the Brazilian Society of Angiology and Vascular Surgery – São Paulo Region (SBACV-SP), arteries function as a kind of “window” for the body’s vascular health. When there are fatty plaques or narrowing in these vessels, this often indicates the presence of atherosclerosis in other regions of the body, such as the arteries of the heart, lower limbs and the cerebral circulation itself.

For this reason, identifying these changes does not just mean evaluating the stroke riskbut also recognize an increase in overall cardiovascular risk. In other words, a carotid plaque can represent an important warning sign for diseases that affect different parts of the circulatory system.

Cause of carotid artery narrowing

Located on both sides of the neck, these arteries are divided into the internal carotid, responsible for cerebral irrigation, and the external carotid, which irrigates structures of the face and neck. The main cause of the narrowing of these vessels is atherosclerosis, a chronic inflammatory process characterized by the accumulation of cholesterol, calcium and fibrous tissue in the artery walls.

One of the main challenges is that the disease usually progresses silently. Many people experience significant narrowing of the carotid arteries without any symptoms. In some cases, the first sign may be a stroke or a transient ischemic attack (TIA), popularly known as a “mini stroke”. Stroke is among the main causes of death and disability in Brazil and around the world, which reinforces the importance of early identification of risk factors.

Main warning signs

About a third of patients presents with a transient ischemic attack before a definitive stroke. Among the main warning signs are:

• Temporary loss of vision in one eye;
• Difficulty speaking or understanding words;
• Weakness or numbness on one side of the body;
• Mouth deviation;
• Sudden changes in motor coordination.

Even when they resolve quickly, these episodes should be considered a medical emergency and require immediate evaluation.

Although often associated with circulatory problems, dizziness is rarely caused by changes in these arteries when it occurs in isolation. In most cases, the symptom is linked to vestibular changes, anxiety, medication use or other benign conditions. When the origin is vascular, there are usually other associated neurological symptoms.

Risk factors for developing the disease

The main ones risk factors for the development of carotid disease include age over 60 years, high blood pressure, diabetes, high cholesterol, smoking, coronary heart disease, peripheral arterial disease and a family history of early atherosclerosis. Dr. Celso Ricardo Bregalda Neves highlights that the risk increases significantly when several of these factors are present simultaneously.

Although obesity and a sedentary lifestyle contribute to the development of atherosclerosis, thin and apparently healthy people can also suffer from the disease due to genetic factors, high family cholesterol, smoking, hypertension or aging. “Physical appearance does not always reflect the health of the arteries”, warns the doctor.

Early diagnosis and treatment help prevent complications

The main test for evaluating the carotid arteries is Doppler ultrasound, a non-invasive, painless, radiation-free and widely available method. The exam allows you to identify atherosclerotic plaques, measure the degree of narrowing of the arteries and help define the treatment more suitable. Its indication is usually aimed at people with important cardiovascular risk factors, a history of stroke or TIA, peripheral arterial disease or significant coronary disease.

Clinical treatment is indicated for all patients with carotid atherosclerosis and includes strict control of blood pressure, diabetes and cholesterol, smoking cessation, regular physical activity, balanced diet and periodic medical monitoring. In cases of more important obstructions, especially when there are associated symptoms, procedures such as carotid endarterectomy, surgery to remove the fatty plaque, or angioplasty with stent implantation may be indicated.

“Stroke continues to be one of the main causes of death and disability in the world. Early detection of plaques and arterial narrowing makes it possible to adopt measures capable of significantly reducing the risk of complications. Prevention continues to be more effective than any treatment carried out after the occurrence of a stroke”, concludes Dr. Celso Ricardo Bregalda Neves.

By Elenice Cóstola