Lumbar and carotid artery stenosis: what is the treatment?

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constriction

What is a stricture? What causes it? What are the related tests and treatments? How can I prevent this pathology? Vascularist and Interventional Veterinary Medicine Segolene De Bruyne, M.D., agreed to answer our questions.

What is a stricture?

“Stenosis is narrowing of blood vesselsThis can generally involve any blood vessel, arteries or veins. Be careful, this is narrow and not an obstacle.” Dr. Segolene De Bruyne explains. “This narrowing is the result of the formation of atherosclerotic plaques (atherosclerosis) that block the lumen of blood vessels. Atherosclerotic plaque is made up of fat and calcium. They impede blood flow. Beyond 60% occlusion, stenosis starts to become noticeable.” she completes “Clinical symptoms (neurological, muscular) may appear. As plaque grows, it can completely block a blood vessel. This is thrombosis. Plaques are called clots or thrombi. Plaques can also cut off and embolize other blood vessels in the brain, for example, if the vessels are small in diameter, this is cerebrovascular accident (CVA). ”.

In summary, stenosis is Continuous narrowing of the caliber of blood vessels or ducts, which may be acquired or congenital. There are as many strictures in the body as there are organs, but the most frequently found are:

  • aortic stenosis (aorta), especially in the elderly;
  • spinal stenosis or spinal stenosis;
  • renal artery stenosis (often associated with hormonal imbalances);
  • pyloric stenosis (intestinal disease affecting babies);
  • pulmonary stenosis and pulmonary atresia, or mitral stenosis;
  • peptic stricture of the esophagus;
  • coronary artery stenosis;
  • carotid artery stenosis;
  • Arterial stenosis.

Where is atherosclerotic plaque located?

The walls of blood vessels are made up of three layers: the intima, media, and adventitia on the side through which blood circulates. Atherosclerotic plaques form at the level of the media..

What types of stenoses are there?

“The most familiar stenosis to the general public is internal carotid artery stenosis. The internal carotid artery is the artery that supplies blood to the brain and eyes, while the external carotid artery forms blood vessels in the face and neck.” Describe the vascular doctor.

The other most frequent stenoses are those located in the arteries of the lower extremities in patients with arteriopathy obliterans of the lower extremities.

What are the risk factors for strictures?

“Stenosis risk factors are cardiovascular risk factors. Some are said to be ‘modifiable.’ Thus, these factors can be reduced by preventive measures or optimized drug treatment. Others are said to be “immutable”. Dr. Segolene De Bruyne explains. “Among the modifiable elements are tobacco (due to oxidizing particles that alter the walls of the container), alcoholAll of drugs (they cause vascular tachycardia and oxidative stress), Dyslipidemia (Hypercholesterolemia, hypertriglyceridemia..), Diabetes, high blood pressure, overweight, lack of exerciseUnmodifiable factors include age, family genetic predisposition, and gender. In fact, women are at higher risk after her 60 years and men after her 50 years..

“To prevent the development of strictures, we must balance diabetes, treat dyslipidemia and arterial hypertension, support withdrawal symptoms (alcohol, tobacco, drugs), encourage weight loss, and consume at least 30 days of Modifiable risk factors should be addressed, such as engaging in adequate physical activity “minutes per day”.

What are the symptoms of stenosis?

“Symptoms depend on the location of the stenosis and its rate of occlusion. Some locations, such as the carotid artery, are completely asymptomatic during the stenosis stage. It is detected only when there is an embolism (embolism) or acute blockage of an artery (thrombosis). Dr. De Bruyne explains. “Arteriopathy occlusive in the lower extremities causes spasms on exertion, called exertional ischemia. The patient is asymptomatic at rest. There are no external traces of the stricture (e.g. skin).”.

are mainly distinguished. heart related stenosisand the Stenosis not related to the heart.

for heart related stenosis, symptoms depend on the location of the stricture.in this way coronary artery stenosis It presents as a myocardial infarction and is detected by chest pain radiating to the jaw and left arm.

of carotid artery stenosisIt can be detected by temporary loss of vision in one eye, deformity of the mouth, or difficulty speaking.

of aortic stenosis May cause angina, shortness of breath, or fainting.

for Noncardiac-related stricturesr, again, symptoms vary by location. Arterial hypertension is seen mainly when: renal artery stenosisin the presence of Esophageal peptic stricturemay be difficult to swallow.

for Lumbar Stenosis, quite common, causes pressure on the roots of the spinal nerves, causing pain. Lumbar stenosis is commonly seen in older people and can lead to sciatica.

For pyloric stenosis in infants, heavy regular vomiting is seen after each bottle ingestion.

How is stricture treated?

After optimizing therapy and addressing cardiovascular risk factors, there are two areas of intervention. ”Surgery or Vascular Rehabilitation”Vascular rehabilitation is usually performed in dedicated hospital centers. It develops more and more at home (because of the lack of structure).

“A multidisciplinary team, including vascular physicians, physiotherapists, and addiction specialists, cares for patients to promote distal angiogenesis in the lower extremities. Developing the ability of blood vessels to compensate for the supply of oxygen and nutrients to muscles.Surgery may be offered alone, but combined treatment with vascular rehabilitation can accelerate recovery and prevent recurrence. “Surgery consists of removing blockages in blood vessels. Either opening the blood vessel and scraping the wall to remove the atherosclerotic plaque, or placing a stent (like a small spring) in the stenosis. ”.

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Is it possible to detect strictures?

“While many stenoses are asymptomatic, screening is essential because they are at risk of progressing to thrombosis, stroke, and chronic acute or severe ischemia of the limb. To detect stenoses, tests are performed. need to do it. doppler echo : Echo-Doppler of the superior aortic trunk, Echo-Doppler of the aorta and peripheral arteries, Echo-Doppler of the lower extremity arteries. This test allows you to observe the movement of blood vessels and blood and detect obstacles. An angiologist explains. “Some tests must be performed on an empty stomach. ”The Echo Doppler is completely painless and reimbursed by health insurance (sector I – sector II optam). It takes about 30 minutes. After the test is completed, the results will be sent to the patient immediately. “This screening is highly recommended for all men over the age of 50 and women over the age of 60, and for all people with cardiovascular risk factors. Prevention is better than cure.” !

In general, the diagnosis of strictures depends on their location.

  • Eco Doppler;
  • to scan;
  • MRI.

Dr. Ségolène Debruyne is a Vascularist, Interventional Veterinarian, former president and current vice-president of the Young Vascular Club (CJMV) under the auspices of the French Society of Vascular Medicine (SFMV). I am servingShe volunteered to build the website macirculation.com In collaboration with the French College of Vascular Medicine. She also participates in the “cardiovascular” screening event. heart bath » Under the auspices of the « act for the hearts of women » foundation that has traveled all over France since 2021.

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