The particularities of evolution of ischemic stroke in patients with carotid artery occlusion (review)

Abstract

Introduction. Worldwide, stroke is the third leading cause of death and the most common cause of disability. According to WHO, 20 million people are affected annually and mortality rate is 5.5 million people. Ischemic stroke accounts for 87% of all strokes. Ischemic stroke in 15-20% is caused by atherosclerosis of large extracranial arteries and in 75% is caused by the occlusion of the cervical internal carotid artery and has an incidence rate of approximately 6 per 100000 people. Aim of the study. To analyze the bibliographic data with reference to the epidemiology, the causes, the risk factors, the clinical presentation and the evolution of the ischemic stroke determined by the occlusion of the carotid artery. Materials and methods. Were analyzed 40 bibliographic sources from the Hinari, PubMed, Medline database. Results. Atherosclerosis is the leading cause of carotid artery occlusion. Since the 1950s it has been shown that the predominant localization of atherosclerosis is the origin of cervical internal carotid artery. In young patients, the occlusion is often caused by carotid artery dissection. Carotid artery atherosclerosis is more common in men and the prevalence increases with age. The non-modifiable risk factors are: age, gender, genetic predisposition, and modifiable risk factors are: high blood pressure, smocking, hypercholesterolemia, diabetes. Atherothrombosis with thromboembolism is considered the major pathological determinant of ischemic stroke. The atheroma progressively deteriorates, due to the growth of atherosclerotic plaque and the formation of thrombi above the plaque. Eventually, the thrombi migrate, occluding the distal cerebral vessels. Atheromatous or cholesterol embolism is less common. Thrombosis in situ causes occlusion by adhesion, activation and aggregation of platelets. Clinically we determine the disorder of consciousness; homonymous hemianopia; contralateral motor deficithemiparesis, hemiplegia; disorders of language- motor, sensitive aphasia and dysarthria. We can determine the carotid occlusion by Doppler examination. Cerebral angiography is the gold standard for the determination of atherosclerotic stenosis, and presents risks of arterial injury, embolism. Treatment options are drugs, endarterectomy and carotid stenting. Conclusions. Carotid occlusion is responsible for an imposing number of ischemic strokes in both the elderly, predominantly caused by atherosclerosis and in young people, being caused by carotid dissection, and the basic risk factors are male sex, high blood pressure, smocking and dyslipidemia. It can be prevented by managing risk factors.