Lesions of the Supra-Aortic Trunks: Carotid Stenosis in Nice
Dr. Ilya Khantalin, Vascular Surgeon in the Alpes-Maritimes
Treatment of Supra-Aortic Trunk Lesions: Carotid Stenosis
Dr. Ilya Khantalin in Nice
Lesions of the supra-aortic trunks, particularly carotid stenosis, are a common vascular surgery pathology, especially among patients with cardiovascular risk factors. These lesions affect the carotid arteries, which supply blood to the brain. When compromised, they may significantly reduce blood flow and lead to cerebral microemboli, thereby increasing the risk of stroke (CVA).
Arterial diseases are currently treated using modern techniques validated by the Haute Autorité de Santé, with a focus on innovation and adherence to recognized surgical protocols.
Vascular diseases are classified as Long-Term Illnesses (Affections de Longue Durée – ALD), allowing for 100% coverage by French Social Security.
What is Carotid Stenosis?
Vascular Surgeon in Saint-Laurent-du-Var
Carotid stenosis is a narrowing of the carotid arteries, typically caused by atherosclerosis—the accumulation of atheromatous plaque on the inner arterial wall. Over time, these plaques harden and narrow the artery, limiting blood flow to the brain.
Major risk factors for this pathology include age, smoking, hypertension, diabetes, and hypercholesterolemia. Carotid stenosis often presents with transient neurological symptoms or a full-blown stroke, such as visual disturbances, muscle weakness, or numbness on one side of the body.
In some cases, the stenosis remains asymptomatic but still requires close monitoring due to the high risk of stroke.
Symptoms of Carotid Stenosis:
- Facial paralysis, such as flattening of the nasolabial fold or deviation of one side of the mouth
- Difficulty speaking or swallowing: speech disorders and impaired swallowing are common
- Weakness or paralysis: patients may experience weakness in the limbs on one side of the body, or even paralysis
- Visual disturbances
Diagnosis and Treatment of Supra-Aortic Trunk Lesions
Vascular Surgery Specialist in Saint-Laurent-du-Var
Diagnosis of Carotid Stenosis
Early detection is crucial to prevent severe complications, including stroke. Diagnosis is based on:
- Clinical Examination: The vascular surgeon assesses medical history and checks for signs of vascular insufficiency such as carotid bruits or possible neurological deficits.
- Carotid Doppler Ultrasound: A non-invasive test that measures blood flow and identifies narrowing zones.
- CT Angiography or MR Angiography: These imaging techniques provide detailed views of the carotid arteries, confirm the diagnosis, and evaluate the severity of the stenosis.
Indications for Treatment
The treatment depends on the degree of narrowing and the presence or absence of symptoms. Two major categories are distinguished:
- Asymptomatic Stenosis: For patients without neurological symptoms but with significant stenosis (typically over 70%), surgical intervention may be considered.
- Symptomatic Stenosis: In patients who have experienced transient symptoms (transient ischemic attacks or TIAs) or a stroke, surgical treatment is often recommended to prevent further events when stenosis exceeds 70%.
Treatment Options for Carotid Stenosis
Several therapeutic approaches exist, with the choice depending on overall health, stenosis severity, and recurrence risk.
Medical Treatment Medical management aims to control cardiovascular risk factors and may include:
- Antiplatelet agents (e.g., aspirin) to prevent blood clots
- Statins to lower cholesterol and slow atherosclerosis progression
- Antihypertensives to regulate blood pressure
- Antidiabetics for diabetic patients to reduce complications This approach is generally recommended for patients with moderate or asymptomatic stenosis and requires strict medical follow-up.
Surgical Treatment: Carotid Endarterectomy This is the gold standard for treating symptomatic carotid stenosis or severe asymptomatic cases. It involves making an incision in the carotid artery to remove the atheromatous plaque, restoring normal blood flow to the brain and reducing stroke risk.
Performed under general or local anesthesia, the procedure requires a few days of hospitalization. While effective, it carries a 1% to 3% risk of neurological deficit, warranting careful candidate selection.
Angioplasty with Stent Placement This endovascular procedure is an alternative for high-risk surgical patients. It involves inserting a stent to widen the narrowed artery. A cerebral protection filter is used to minimize embolic risk.
Stenting is recommended for patients who are not surgical candidates or have anatomical complexities. However, the recurrence risk is slightly higher compared to endarterectomy.
Postoperative Follow-Up and Recurrence Prevention
Regardless of the treatment, postoperative monitoring is essential to track disease progression and prevent recurrence. Follow-up includes:
- Regular consultations with the vascular surgeon to monitor general health and risk factors
- Periodic Doppler ultrasounds of the supra-aortic trunks to detect new stenoses
- Adjustments in medical treatment as needed, particularly blood pressure and cholesterol control
After surgery, close monitoring is implemented during the initial months to prevent immediate complications. Lifestyle recommendations are also critical, including smoking cessation, regular physical activity, and a balanced diet to lower the risk of new lesions.
Carotid stenosis requires prompt and effective management to avoid serious neurological outcomes like stroke. Thanks to advances in vascular surgery, several therapeutic options are now available. The choice of treatment must be personalized based on the patient’s condition and medical profile. Ongoing follow-up with a vascular surgery specialist is essential to ensure optimal outcomes and reduce recurrence risks.