Occlusion of ICA

Question 1

what is occlusion of ICA?

Answer 1

Carotid occlusive disease, also called carotid stenosis, is a condition in which one or both of the carotid arteries becomes narrowed or blocked. It is a serious condition that increases the risk of stroke if left untreated.

If an artery becomes completely blocked (which is called carotid occlusion) or if piece of the blockage breaks off and travels to a smaller vessel where it completely blocks blood flow, a part of the brain may be completely deprived of oxygen, leading to the destruction of brain tissue.

A partial blockage, where one of both carotid arteries becomes narrowed, is called carotid stenosis. The carotid arteries are large enough to allow good short-term blood supply even when they start to narrow, and other arteries sometimes expand to compensate for the reduced flow, but carotid stenosis can still cause a stroke or a transient ischemic attack (TIA).

Question 2

Cause of occlusion of ICA

Answer 2

1. Atherosclerosis (90% of all cases)
2. Aneurysms
3. Arteritis
4. Carotid dissection
5. Fibromuscular dysplasia
6. Vasospasm

Question 3

Risk factors of occlusion of ICA

Answer 3

1. High cholesterol levels, especially high “bad” cholesterol (LDL)
2. High blood pressure
3. High levels of homocysteine in the blood
4. Diabetes
5. Smoking
6. Obesity
7. Family history of stroke

Question 4

Symptoms of occlusion of ICA

Answer 4

If carotid occlusive disease is not detected during a routine exam, it may reveal itself with a neurological episode called a transient ischemic attack, or TIA, often referred to as a “mini-stroke.”

Symptoms of TIA: Weakness, tingling, or paralysis on one side of the body

• Slurred speech or difficulty speaking
• Confusion
• Vision disturbances, eye pain, or loss of vision in one eye
• Dizziness, or difficulty maintaining balance
• Severe headache

Question 5

How Is occlusion of ICA Diagnosed?

Answer 5

During physical examination the doctor can listen to the blood flow of the patients carotid artery. The doctor can hear bruits ( lack of bruits sounds doesn’t exclude a carotid stenosis) and then should further investigate :

1. Echo color Doppler USG - screening method of choice ( very accurate and non-invasive)
2. Carotid angiography- Gold standard but may be associated with small risk of complications.
3. MR- angiograpgy / angio-CT- less invasive

Question 6

Treatment of occlusion of ICA.

Answer 6

Medication:

• Antihypertensives for high blood pressure
• Statins to reduce cholesterol levels and stabilize the atherosclerotic plaque.
• Antiplatlet therapy.
• Medication to control diabetes

Surgical:

• Carotid angioplasty (balloon angioplasty)
• Carotid artery stenting
• Carotid endarterectomy- carefully opening the carotid artery and removes the blockage, reconstructing the artery walls to ensure smooth blood flow. In some cases, the neurosurgeon may patch in part of a healthy blood vessel from the patient’s leg, or use a synthetic blood vessel, to replace the damaged artery.