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Duplex sonography of the carotid arteries:

High-resolution ultrasound scans reveal vascular changes in the early stages.  This is why duplex sonography of the carotid arteries can be one of the most important examinations for determining each individual’s risk of stroke and heart attack.
restriction of blood circulation, it can even to expose early forms of vascular changes. To do this, the so-called intima media thickness (IMT or IMD) is measured.  This is done by a computer analysis of certain sections of the blood vessel walls using high spatial resolution. If thickness is detected in a particular wall section, this may be an important indication of an incipient or already advanced arteriosclerosis. Normal values were established in extensive clinical studies and are now an integral part of preventive care. An important requirement - in addition to the technical expertise - is a modern ultrasound machine. Advanced vascular changes show up as so-called plaques. Deposits of fat and the subsequent inflammation in the wall of the blood vessel lead to an increased narrowing of the blood vessels.
Duplex-Sonographie: Plaque-Darstellung an den Halsgefässen - Risiko für Herzinfarkt und Schlaganfall Farb-Doppler: Darstellung des Blutflusses in den Halsgefässen
High resolutional image of the carotid artery Color-Doppler image of blood-flow in the
carotid artery
Clinical studies have shown that for different age groups there is a clear connection between the IMT and future events (e.g. stroke, heart attack). If changes have already occurred in blood vessels located in the neck, this requires special attention. A severe narrowing of the carotid arteries may be associated with circulatory disorders of the brain vessels, and therefore can result in decreased brain function. *But even less substantial changes pose a significant risk: So-called unstable plaques combined with a relatively low blood flow restriction can be the cause of a stroke. Modern examination techniques such as high resolution or contrast-enhanced ultrasound, or MRI scans may be capable of identifying such plaques.  This is part of the focus of our interdisciplinary examinations by our cardiac and vascular specialists and neurologists when they examine and advise you.
 

Recognizing the early stages of arteriosclerosis: for the prevention of stroke and heart attack, an important screening

High-resolution depiction of blood vessels located in the neck is one of the most important examinations for determining the risk of stroke and heart attack. Ultrasound detects not only a narrowing of the blood vessel, which can lead to a debilitation of blood circulation, but even uncover early forms of vascular change. As mentioned earlier, the intima media thickness (IMT) measurement is a useful tool. Specific wall sections of blood vessels are computer analyzed with high spatial resolution. If the wall section measurement reveals abnormal thickness, this may be an important indication of an incipient or already advanced arteriosclerosis.
Intima Media Dicke: Vorhersage Herzinfarkt und Schlaganfall? Liegen Plaques in Halsgefässen...  
Assessment of the so-called intima media thickness (IMT)  
In großen klinischen Untersuchungen wurde für verschiedene Altersgruppen ein klarer Zusammenhang zwischen der IMT und zukünftigen Ereignissen (z.B. Clinical studies have shown that for different age groups there is a clear connection between the IMT and future events (e.g. stroke, heart attack). If other risk factors are present, such as hypertension, diabetes, dyslipidemia, or nicotine consumption, depending on the particular IMT value, a specific treatment may be beneficial. It is important to note, vascular changes in the body usually does not occur in isolation. If any changes to the neck vessels are found, other vascular regions, especially the coronary arteries, should be examined. Very precise and gentle examination procedures are available today. 
 
Especially those changes affecting the neck vessels require special attention. Severe narrowing of the carotid arteries may be associated with circulatory disorders of the brain vessels. ²But even less substantial changes pose a significant risk: So-called unstable plaques combined with a relatively low blood flow restriction can be the cause of a stroke. In order to ensure optimal care, we here at the Isar Heart Center take an interdisciplinary approach to treating such vascular changes. Cardiologists, vascular specialists and neurologists work hand-in-hand along with diabetic and blood pressure specialists. Through this interdisciplinary networking, optimal treatment paths can be taken based on a goal-oriented and careful diagnosis. Modern examination techniques such as high resolution or contrast-enhanced ultrasound, or MRI scans may be capable of identifying such plaques.
 

Drug treatment of vasoconstriction (narrowing of the arteries)

Stroke prevention and inhibiting the vasoconstriction are the main targets of drug therapy. Many patients are unexpectedly surprised upon receiving a diagnosis of "plaque" or vasoconstriction. Arteriosclerosis is a gradual process which takes place over years and decades. An imbalanced metabolism (e.g. fat or sugar metabolism), or the strain of high blood pressure, together with external harmful agents (e.g. nicotine), may cause inflammation in the vessel wall. The expandability and the elasticity of the blood vessel are greatly reduced, if not eliminated, in the relatively early stages. It is followed by the deposit of fats (cholesterol) in the vessel wall and this leads to the formation of so-called plaques. These are initially flat and do not restrict the vessel.

 
Ablagerung in den Halsgefäßen: Ultraschall macht Plaques sichtbar - Risiko für Herzinfarkt und Schlaganfall
Even smaller plaques are visible by ultrasound.
 
If plaques are found in a high-resolution vascular ultrasound, the first step is to make an accurate analysis of the causes of disease. For this a detailed medical record of the patient is necessary, also, lab results and a blood pressure diagnosis play a central role. After an accurate risk profile assessment,  the optimal treatment can be determined and, if necessary, the fat and sugar metabolism optimized, and if high blood pressure medication is required, it should preferably be one that can have a positive impact on the inflammatory processes in the vessel wall. With consistent treatment and adherence to the recommendations for a change of life-style, early vascular changes may even be reduced. High-resolution ultrasound can be also used to assess the success of treatment. A serious complication of arteriosclerosis is the "tearing" of plaques. This occurs when plaques expand, or grow.
 
Assessment of blood-flow velocities
If in this growth process the top, protective layer of cells (endothelium) is damaged, blood clots (thrombi) can form on the now exposed surface, which later can occlude the vessel (infarct, or restrict), or wash away as a so-called embolus and cause a stroke. If this occurs, the treatment calls for a so-called anti-platelet aggregation inhibitor, the most common being acetylsalicylic acid, better known as aspirin.
Aggregation inhibitors prevent the platelets (thrombocytes) from attaching to the endothelial injury. Recent studies have indicated that not every patient with a plaque actually has a need for platelet inhibitors. 
 
Due to the possibility of negative side-effects such as bleeding (stomach, brain), serious consideration must be given as to whether this treatment is useful and safe for each individual patient.  If a high degree of blood vessel narrowing is already present, medication is often not sufficient. 
 

Factors which increase the risk of stroke include:

High blood pressure
Smoking
Diabetes
Vascular calcification
Bleeding disorders
Cardiac arrhythmia
Other vascular conditions

 

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