The head of the Angiology and Vascular Surgery Service at the Ruber Internacional Hospital, Pablo Gallo, has warned that stenosis in the carotid arteries can progress silently until it leads to a stroke, which is why he emphasizes the need to closely monitor cardiovascular risk factors.
Carotid stenosis, mainly caused by the accumulation of atheromatous plaques in the carotid arteries, is one of the causes of stroke, so its early diagnosis and an early approach are key to avoiding neurological damage and permanent sequelae.
"The problem is not only that the artery narrows and blood flow decreases. An atheromatous plaque can also become unstable, detach small fragments, and cause the obstruction of a cerebral artery," Gallo explained.
This pathology can evolve for years without giving clear signals. However, advanced age, high blood pressure, tobacco consumption, diabetes, high cholesterol, obesity, lack of exercise, and family history of cardiovascular disease increase the likelihood of developing atherosclerosis and, consequently, carotid disease.
"Atherosclerosis is not a disease exclusive to the carotids, but a process that can affect different arterial territories throughout the body. Therefore, when faced with a patient with such risk factors or with known cardiovascular disease, we must carry out a global assessment of their vascular situation," the specialist indicates.
When carotid stenosis begins to manifest, symptoms usually appear suddenly. The sudden loss of strength or sensitivity in the face, an arm, or a leg —especially on one side—, difficulties in articulating words or understanding language, and sudden loss of vision in one eye are signs that should raise suspicion of a possible cerebrovascular event.
In certain cases, these neurological signs resolve on their own after a few minutes or hours, which is called a transient ischemic attack (TIA). "The disappearance of symptoms does not mean that the problem has disappeared. A TIA should be considered a warning sign and requires urgent medical assessment, as it may indicate a subsequent risk of stroke," Gallo emphasizes.
For this reason, in the face of the sudden appearance of symptoms compatible with stroke or TIA, one should not delay the consultation or wait for them to remit spontaneously, but rather go immediately to the emergency services.
According to the expert, one of the advantages of vascular study is that it incorporates non-invasive tests such as 'Eco-Doppler', which allows identifying atheroma plaques and assessing the degree of narrowing of the artery. This analysis can be expanded with imaging techniques such as 'Angio-CT', 'Angio-MRI', and arteriography to obtain a more complete assessment.
"The important thing is not only to know if there is a plaque, but to determine what degree of stenosis it produces, what that lesion is like, whether the patient has presented symptoms, and what their individual risk is. All these elements are what allow us to decide the most appropriate strategy," explains Gallo.
NOT ALL CAROTID STENOSIS REQUIRES SURGERY
The specialist clarifies that the finding of carotid stenosis does not automatically imply resorting to surgical intervention. Management should be adapted to each case, with strict control of cardiovascular risk factors and the introduction of drugs that help stabilize the plaque and prevent the narrowing from advancing, which constitutes a basic pillar of treatment.
In patients with advanced stenosis, presence of symptoms, and a high risk of stroke, surgery is recommended, which consists of removing the plaque responsible for the obstruction and restoring adequate blood flow in the affected artery.
Moreover, prevention remains essential: quitting smoking, keeping blood pressure, cholesterol, and diabetes under control, exercising regularly, maintaining an adequate weight, and following a balanced diet are fundamental measures both to prevent the onset of cardiovascular disease and to slow its progression.