Carotid artery stenosis- Diagnosis, Risks and Treatment in India
Carotid Artery Stenosis in India is a good option for those who are seeking low cost but high quality medical treatment. The cost of various medical treatments / surgeries in India is 60-70 % lower than what it costs in the developed nations like the US or UK. It is natural to assume that low cost could mean low quality. But it is not true as far as India is concerned. Various corporate Indian Hospitals catering various medical treatments and surgeries including the Carotid Artery Stenosis in India are JCI accredited, ISO certified (the stringent rules set by these quality governed bodies to keep a check on the quality and hygiene service in the hospitals) and hence at par with the best hospitals in the west. These are the factors which drives the medical tourists all across the globe to opt various medical treatments including the Carotid Artery Stenosis in India.
What isCarotid Artery Stenosis?
Carotid Artery stenosis is a narrowing or constriction of the inner surface (lumen) of the carotid artery, usually caused by atherosclerosis. Carotid artery disease is a condition in which a fatty material called plaque builds up inside the carotid arteries. You have two common carotid arteries one on each side of your neck that divide into internal and external carotid arteries. The internal carotid arteries supply oxygen-rich blood to your brain. The external carotid arteries supply oxygen-rich blood to your face, scalp, and neck.
Diagnosis of Carotid Artery Stenosis
Carotid artery disease is usually diagnosed by colour flow duplex ultrasound scan of the carotid arteries in the neck. This involves no radiation, no needles and no contrast agents that may cause allergic reactions. This test has moderate sensitivity and specificity, and yields many false-positive results. Typically duplex ultrasound scan is the only investigation required for decision making (including proceeding to intervention) in Carotid Artery stenosis. Occasionally further imaging is required. One of several different imaging modalities, such as angiogram, computed tomography angiogram (CTA) or magnetic resonance imaging angiogram (MRA) may be useful. Each imaging modality has its advantages and disadvantages – the investigation chosen will depend on the clinical question and the imaging expertise, experience and equipment available.
How Does Carotid Artery Disease Happen?
Like the arteries that supply blood to the heart — the coronary arteries — the Carotid arteries can also develop atherosclerosis or “hardening of the arteries” on the inside of the vessels.
Over time, the buildup of fatty substances and cholesterol narrows the Carotid arteries. This decreases blood flow to the brain and increases the risk of a stroke.
A stroke — sometimes called a “brain attack” — is similar to a heart attack. It occurs when blood flow is cut off from part of the brain. If the lack of blood flow lasts for more than 3 to 6 hours, the damage is usually permanent. A stroke can occur if:
- § The artery becomes extremely narrowed
- § There’s a rupture in an artery to the brain that has atherosclerosis
- § A piece of plaque breaks off and travels to the smaller arteries of the brain
- § A blood clot forms and obstructs a blood vessel
Strokes can occur as a result of other conditions besides carotid artery disease. For example, sudden bleeding in the brain, called intracerebral hemorrhage, can cause a stroke. Other possible causes include:
- § Sudden bleeding in the spinal fluid space — subarachnoid hemorrhage
- § Atrial fibrillation
- § Cardiomyopathy
- § Blockage of tiny arteries inside the brain
Carotid Artery Stenosis Treatment
The Options for Carotid Artery Stenosis treatment include:
- § Medical management alone (an antiplatelet drug (or drugs) and control of risk factors for atherosclerosis)
- § Medical management plus carotid endarterectomy (surgical removal of the atheroma)
- § Medical management plus carotid stenting
The goal of Carotid Artery Stenosis treatment is to reduce the risk of stroke (cerebrovascular accident). Intervention (carotid endarterectomy or carotid stenting) can cause stroke, however where the risk of stroke from medical management alone is high, intervention may be beneficial. In selected, high-risk trial participants with asymptomatic severe Carotid Artery stenosis, carotid endarterectomy by selected surgeons reduces the 5-year absolute incidence of all strokes or perioperative death by approximately 5%. In excellent centers, carotid endarterectomy is associated with a 30-day stroke or mortality rate of about 3%; some areas have higher rates.
Clinical guidelines (such as those of NICE)(NICE = (United Kingdom’s) National Institute for Clinical Excellence) recommend that all patients with Carotid Artery stenosis be given medication, usually anti-hypertensive drugs, anti-clotting drugs, anti-platelet drugs (such as aspirin), and especially statins (which were originally prescribed for their cholesterol-lowering effects but were also found to reduce inflammation and stabilize plaque).
NICE and other guidelines also recommend that patients with symptomatic Carotid Artery stenosis be given carotid endarterectomy urgently, since the greatest risk of stroke is within days. Carotid endarterectomy reduces the risk of stroke or death from carotid emboli by about half. For people with stenosis but no symptoms, the surgical recommendations are less clear and controversial. Such patients have a historical risk of stroke of about 1-2% per year. Carotid endarterectomy has a surgical risk of stroke or death of about 2-4% in the best institutions. Carotid endarterectomy reduced major stroke and death by about half, even after surgical death and stroke was taken into account. According to the Cochrane Collaboration the absolute benefit of surgery is small.
Benefits of endarterectomy are greater than those of stenting.
What Are the Risk Factors for Carotid Artery Disease?
The risk factors for carotid artery disease are similar to those for other types of heart disease. They include:
- § Age
- § Smoking
- § Hypertension (high blood pressure) — the most important treatable risk factor for stroke
- § Abnormal lipids or high cholesterol
- § Diet high in saturated fats
- § Insulin resistance
- § Diabetes
- § Obesity
- § Sedentary lifestyle
- § Family history of atherosclerosis, either coronary artery disease or carotid artery disease
Men under the age of 75 have a greater risk than women. Women have a greater risk over the age of 75. People who have coronary artery disease have an increased risk of developing carotid artery disease. Typically, the carotid arteries become diseased a few years later than the coronary arteries.
Why Carotid Artery Stenosis in India?
Many international patients prefer Carotid Artery Stenosis in India because it is available at various Indian Hospitals in cities like Mumbai, Bangalore, Hyderabad, Chennai and New Delhi at an affordable price. Surgery cost in India is quite minimal when compared to other countries around the globe. India boasts of a good number of quality doctors and well-equipped hospitals to offer the best of treatments to medical patients. From neighboring countries to other developed nations, there are many international patients traveling to India for world-class medical treatments including the Carotid Artery Stenosis in India that come at a fraction of what they generally cost. Corporate Indian hospitals are equipped to handle all phases of heart diseases from the elementary to the latest clinical procedures like interventional cardiac catherisation and surgical cardiac transplants. Their success rate at an average of 98.50% is at par with leading cardiac centers around the world.
Source by Dr. Seema Mehta (indianHealth)