January 24, 2022 Author : Germano do Carmo The suspicion of a link between neurological disorders and problems in the blood vessels that transport blood to the head dates back to antiquity. In the 19 th century, it became known that among these problematic vessels were the carotid arteries . In the second half of the 20 th century, clinical neurological consequences of lesions in carotid arteries were described. Medical developments in the last century, with important Portuguese contributions, allow today: Identify patients at risk for carotid disease; Diagnose them accurately; Treat them effectively and thus contribute to the prevention of strokes. Yet, strokes remain a major cause of death and disability in the Western world. When there is a first stroke, it is fatal in almost 40% of cases; Among people who survive, half become dependent and 20% will repeat the stroke. Almost all strokes – about 87% – are ischemic, that is, they are due to an insufficient amount of blood reaching the brain. Injuries to the carotid arteries are one of the possible causes of this insufficiency. What carotid injuries are these? The most important carotid lesions as a cause of stroke are atherosclerosis lesions . Atherosclerosis is an accumulation of fat and other substances plaques in the artery walls . Over time, this accumulation reduces the caliber of the arteries, which become narrower (stenosis) and can even become blocked. Fragments of atherosclerotic plaques can also break off, flowing in the blood and that can block thinner arteries. Whether due to stenosis or blockage of arteries that irrigate brain, blood flow is affected , and brain cells are deprived of oxygen and nutrients. This deprivation can be transient (causing a transient ischemic attack or TIA) or more severe, resulting in a stroke which consequences depend, among other things, on the area of the brain affected. The identification of age, tobacco consumption, diabetes, high blood pressure and high blood cholesterol levels as factors that increase the risk of atherosclerosis easily explain the high number of strokes in the western population. An important Portuguese contribution António Egas Moniz and cerebral angiography In 1927, Egas Moniz, the Portuguese neurosurgeon who received the Nobel Prize in Physiology and Medicine, used on a live patient the technique of cerebral angiography that he had previously developed, demonstrating unequivocally the relationship between carotid disease and neurological symptoms . João Cid dos Santos and endarterectomy The era of carotid revascularization surgery began in 1947 when the Portuguese physician João Cid dos Santos described the endarterectomy technique, that is, the t echnique that allows the removal of an atherosclerotic lesion from the interior of an artery in order to unclog it. This technique was later adopted all over the world and continues to be, both in its traditional form and with developed adaptations, the gold standard in the treatment of most atherosclerotic disease of the carotid arteries cases. The world we know could be different Among the personalities who have played important roles in contemporary history, some have been victims of stroke , for example: Vladimir Ilyich Ulianov, or Lenin , head of the Russian government until his death in 1924 at the age of 54, had several transient ischemic attacks. After these, a stroke left him with the entire right side of his body paralyzed. He died of his third stroke at age 54. His regret at having elevated Stalin to such high places in the party and state apparatus and his desire to replace him with Trotsky is known. Paul von Hindenburg , opponent of Hitler, commanded the imperial army and was German president until he died at the age of 86, in 1934, due to a stroke. The year before his death he appointed Hitler chancellor. US President Franklin D. Roosevelt had severe symptoms of cerebrovascular disorders in 1943, two years before he died. Whether this disease may have affected the Yalta (Crimea) agreements in 1945 and the Cold War that followed is a matter of discussion. Roosevelt died of stroke 4 months after the stroke agreements were signed. If 100 years ago it was known who should be evaluated for the probability of carotid disease and carotid revascularization surgery already existed, the current world might not be the one we know . Carotid revascularization surgery at Hospital da Luz Between January 2007 and December 2021, 296 patients with critical lesions of the internal carotid artery were operated on at Hospital da Luz Lisboa . All lesions had a stenosis degree higher than 70%; 66.2% of the patients were symptomatic, that is, they had had transient ischemic attacks or previous cerebrovascular accidents 40.2% of the patients had bilateral lesions, 10.1% had occlusion of the contralateral internal carotid artery; 8.1% were operated on sequentially on both internal carotid arteries and therefore, in total, 320 carotid revascularization surgeries were performed. Mortality was 0.31% The rate of perioperative neurological accidents was 0.62% The average length of stay was 2.75 days. Meet the vascular surgery clinical tea from Hospital da Luz and book your consultation The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
