Why is it important to carry out a color Doppler ultrasound of the carotid arteries even if you are well? And when is it appropriate to do so? Doctor Davide Foresti, specialist in Vascular Surgery in Polytherapy, tells us about it.
Carotid stroke
To answer these questions we must start from some considerations. The carotid arteries are the arteries that carry blood to the brain. The pathological narrowing (stenosis) of one of these is closely linked, beyond certain values, to the possibility of having a stroke. And stroke is responsible for even serious and permanent disability and, in even more serious cases, death. In industrialized countries like Italy, stroke is the leading cause of disability and the third cause of death in people over 65 years of age. This is why people over 55-60 years of age should undergo a color Doppler ultrasound examination. Especially if they are familiar with atherosclerosis (the plaque in the arteries that causes their narrowing) or suffer from it themselves. And even if they are familiar with or suffer from hypertension (high blood pressure), dyslipidemia (high cholesterol), diabetes, cigarette smoking and overweight. These are risk factors which – however – will need to be corrected with drugs as early as possible. It should be done even if the color Doppler ultrasound examination does not reveal the presence of atherosclerosis in the carotid arteries. Precisely to prevent this from forming.
Color Doppler ultrasound and plaque
The color Doppler ultrasound exam gives the possibility of studying the plaque from a morphological point of view, i.e., how it appears visually, continues Dr. Foresti. This allows us to identify the most dangerous forms that can produce emboli, i.e., the detachment of plaque fragments that can travel back towards the brain. This is the calcific plaque, which is also the most stable. The plaque can also be lipid or, again, irregular or even with a hemorrhagic or ulcerated component, the most unstable and dangerous. Unlike ultrasound, color Doppler ultrasound also allows us to study the effects produced by stenosis on the effectiveness of the blood supply to the brain. And it also allows you to correlate the speed of blood flow with the severity of the stenosis.
The cure
The result of the color Doppler ultrasound examination allows the best treatment to be adopted. If the carotid stenosis is less than 70%, there is no indication for surgical correction since the use of drugs (such as cardioaspirin and statins) is sufficient. However, a program of instrumental checks must also be set up over time to monitor the plaque and its possible growth. If the stenosis is less than 50%, the checks will be on an annual basis. If it is higher, the checks will be every 6 months. In the event that there is no presence of plaque but only of the risk factors indicated above, checks can be scheduled for 2-3 years. When carotid stenosis is greater than 70%, the risk of stroke becomes high, medical therapy is not sufficient and the possibility of resorting to surgical or endovascular treatment must be evaluated. In this case, to have a correct indication and above all to decide which technique to tackle the problem with, other tests must be carried out which serve to know exactly the entire vascular tree, from the thorax to inside the head. This is called AngioCT or MRI. The analysis of Color Doppler and AngioCT or MRI allows the clinician to indicate the best surgical solution.
The surgery
There are two possible surgical therapies for carotid stenosis: the traditional “open” one and the endovascular one. The vascular surgeon, who knows how to perform both, decides on a case-by-case basis which is the most suitable. Given the sensitivity of the district in question, every intervention certainly has a danger. In some cases, it could even cause a stroke as a complication. This can happen due to the manipulation and closure of the vessel during the operation or due to the passage of the endovascular instruments with the minimally invasive technique. The chances of this happening are very low and in any case much lower than the risk of not intervening.
Prevention is key
The role of prevention is fundamental, concludes the Politerapica specialist. An operation on a plaque that has had symptoms is much riskier than one on an asymptomatic plaque. Discovering it before it gives signals therefore makes the difference. And an ultrasound color Doppler is enough!