Vascular atherosclerosis: diagnosis and treatment

One of the most common vascular diseases in the modern world is atherosclerosis. Every third resident of our country over the age of 65 suffers from the consequences of cholesterol deposition on the inner walls of the vessels of the heart, brain and limbs, and according to WHO, in developed countries, mortality from diseases caused by atherosclerosis is up to 50% of all cases.

Despite this prevalence, there is no general understanding of the causes of atherosclerosis. This is a complex disease, the study of which uses the latest advances in medical science. Therefore, you should not try to independently diagnose atherosclerosis and self-medicate! The correct diagnosis can only be made by a professional using modern laboratory and instrumental methods.

Diagnosis of atherosclerosis always consists of several main stages:

studying patient complaints, identifying symptoms of the disease;
examination of the patient;
studying the medical history, identifying risk factors associated with the development of the disease;
The main and most important stage is laboratory and instrumental diagnostic methods.

Clarification of the patient's symptoms and complaints

At the first stage, the doctor compares the patient’s complaints with the symptoms of the disease. Symptoms of atherosclerosis, depending on the location and stage of development of the disease, vary greatly, but a number of common ones can be identified:

attacks of angina (pain in the chest, left shoulder, forearm, occurring after physical exertion and stress), arrhythmia. Most often, such symptoms are a sign of atherosclerosis of the heart vessels;
painful sensations in the limbs , numbness, lameness are signs of atherosclerosis affecting the vessels of the legs and arms;
headaches, memory and intelligence impairment are symptoms of cerebral atherosclerosis.

Where do they look for cholesterol plaques in blood vessels?

During the IMT study, cholesterol plaques are looked for in the carotid artery, with angiography - in the coronary vessels of the heart (the procedure is invasive), with computed tomography of the thoracic region - in the coronary vessels (without internal intervention, but using x-rays).

With traditional ultrasound - in blood vessels (possibly the carotid artery). Indirect methods, such as, for example, measuring pressure under load, do not involve searching for atherosclerotic plaques at all, but provide an assessment of indirect signs. This also includes monitoring heart rate after exercise and assessing energy consumption during physical work.

Determination of the ankle-brachial index

The ankle-brachial index (ABI) is an important indicator in the diagnosis of atherosclerotic vascular lesions. This is the ratio of blood pressure in the lower leg to the pressure in the arm. At certain ABI values, a professional physician can detect atherosclerosis of peripheral vessels in the early stages and prevent its development.

At the Center for Pathology of the Circulatory Organs, determining ABI takes no more than 1 minute using the Boso ABI-System 100 system, as well as the Japanese VaSera VS-1000 Fukuda Denshi sphygmomanometer. The procedure is a simultaneous measurement of pressure on the limbs and does not require special preparation of the patient.

For a detailed study of blood vessels, our equipment also measures the speed of propagation of the pulse wave. High speed is a signal to start treatment. This is a characteristic indicator for the development of atherosclerosis.

How to detect cholesterol plaques yourself

How to detect cholesterol plaques at home? The methods, of course, are not at all effective, because... There are no symptoms of high cholesterol levels in the blood and the presence of atherosclerotic plaques, but if it is not possible to undergo a carotid IMT study, CT coronography or even angiography, you can monitor your condition:

level of physical endurance (the higher the better);
amount of fiber consumed (more is better);
frequency of fish consumption (more is better);
systolic (upper) pressure (ideal - around 120, and always no more than 140);
body mass index and excess body fat (less is better, BMI should be no more than 24).

Energy expenditure as a way to independently measure the number of cholesterol plaques

In the gym (gym) or at home, but on sports equipment, you can assess the level of physical fitness by energy expenditure (calorie consumption) during physical exercise. For example, race walking burns about 240 - 300 kcal per hour under normal conditions, if much more is burned, this is already a reason to think about studying the condition of the blood vessels.

The methodology for assessing the level of cholesterol plaques in blood vessels based on measuring the body's energy expenditure is based on the concept of metabolic equivalent (MET). 1 MET corresponds to the amount of oxygen burned that is consumed at rest, lying down.

1.5 - 4 MET is spent on work in the garden or around the house.
For construction and installation work - 4 - 8 MET.
When jogging (up to 5.4 km/h or 1.5 m/s) and walking uphill (with an incline of no more than 14%) - 8 - 8.3 MET.
When exercising on a treadmill (depending on speed) – 5 – 18 MET.

The MET scale is used in stress texts. Extremely poor fitness is when a person is unable to reach the 4 MET level of exercise. The norm is considered to be the unimpeded achievement of a value of 10 - 12 METs, 15 is a good result. People who are able to achieve 15 METs almost never perform poorly on IMT.

Monitoring blood pressure is another indirect sign of the level of atherosclerotic plaques

Normal pressure, as indicated above, is 120/80, excellent - 110/70, however, after physical activity, the upper pressure can increase to 150, 160 and even 170. The lower pressure is 10 - 20 points less (in trained people - by 40 or more). Those. a trained person with intense training can have a blood pressure of 170/40! And it will be normal.

If the resting pressure is elevated (between 120/80 and 140/90), then during training the systolic pressure can reach 180 - 200, and the diastolic (lower) pressure can increase by 5 - 9 points or remain unchanged. High blood pressure itself is one of the reasons that accelerates the growth of atherosclerotic plaques. But the conditional norm in the described case will be its value under load up to 190/85.

If the resting pressure exceeds 140/90 mmHg. Art., then under load the systolic pressure can exceed 200, and the diastolic pressure increases by 10 points or more. This causes the blood vessels to contract, which is an undesirable reaction. Blood pressure can reach 200/105.

ECG, stress ECG and EchoCG

An ECG is used if coronary heart disease is suspected, the consequence of which is most often atherosclerosis. This is a universal method in cardiology, and no doctor can prescribe treatment without it.

In order to make the heart work in a stressful situation, for example, during physical activity, a stress ECG is used. For this purpose, our center is equipped with a special General Electric bicycle ergometer. Simulating cycling gives the doctor an understanding of how the vessels that supply the heart with blood work during exercise.

Echocardiography (EchoCG) is an informative way to examine the heart and coronary vessels with ultrasound. A diagnostician can assess in real time the nature of wall damage, the presence of blood clots, and the speed of blood flow.

Success in the treatment of atherosclerosis depends entirely on timely diagnosis . Since this disease cannot be cured, the patient needs to monitor his health for the rest of his life, see a doctor and undergo periodic examinations of the vascular system. At the Center for Pathology of the Circulatory Organs, we use only the most modern equipment from European, American and Japanese manufacturers. Our experienced specialists will provide you with all the necessary assistance, prescribe the correct diagnosis and treatment of atherosclerosis.

How to determine cholesterol plaques in blood vessels by measuring carotid artery IMT

To determine cholesterol plaques in the carotid artery (which is incomparably easier to reach than the coronary vessels), the patient only needs to lie quietly on the couch for 10 to 12 minutes. The procedure itself boils down to an ultrasound examination of the carotid artery: a special gel is applied to the neck, and the doctor takes about 12 photographs of the right and left arteries from different angles.

The resulting images are processed on a computer. The measurement accuracy is several hundredths of a millimeter. The obtained values are compared with the average statistical values - and from this comparison one can, for example, estimate the age of the circulatory system. The procedure for high blood cholesterol levels should be repeated every 1 to 2 years (to assess changes in plaque size).

Regular observations make it possible to predict the risks of complications and adjust diet and lifestyle to the needs of the cardiovascular system. An alternative to changing IMT in terms of accuracy is only invasive (internal) angiography procedures.

Is vascular atherosclerosis visible on MRI of the brain?

Magnetic resonance imaging of intracranial arteries allows us to assess the condition of the walls, lumen, and functionality of the bloodstream. An MRI of the brain with a vascular program will show the following pathological changes:

narrowing of the artery lumen, impaired blood flow;
thickening, decreased elasticity of the vascular wall at the site of cholesterol plaque formation;
foci of ischemia in cerebrovascular accidents;
artery aneurysm due to deformation of the walls by cholesterol deposits;
intracranial hematomas formed due to rupture of a vessel;
violation of the integrity of the arterial wall.

Magnetic resonance scanning is one of the most informative types of instrumental research of the cerebral circulatory system. MRI shows the development of atherosclerosis of cerebral vessels at the stage of slight (from 1 mm) wall thickening.

A non-stenotic process is characterized by the presence of a volumetric compaction without a significant effect on blood flow. In this case, there are no signs of ischemia of the cerebral substance, the disease is asymptomatic.

Cerebral vascular lesions on MRI

When the lumen of the artery narrows by 15-20%, stenosing atherosclerosis is diagnosed. With age, vascular damage intensifies, and signs of insufficient cerebral circulation increase. MRI images of the head show areas of ischemia.

Magnetic resonance scanning of the intracranial space is carried out to assess the state of the circulatory system and brain structures. MR angiography makes it possible to differentiate cerebral atherosclerosis and other vascular pathologies (neoplasms, inflammatory processes, etc.). In some cases, only hardware diagnostics makes it possible to determine the causes of cerebrovascular accidents.

What is atherosclerosis?

The disease is classified as a systemic pathology of the circulatory network. Atherosclerosis develops in large vessels, small capillaries function without disturbances. In terms of frequency, intensity and volume of damage, processes in the area of the aorta, coronary and bifurcation of the carotid arteries take first place.

Atherosclerosis is a stenosis or occlusion of the bloodstream due to the formation of cholesterol deposits on the walls of the vessel. The disease develops against the background of metabolic disorders, when LDL (low-density lipoproteins) begin to predominate in the body. In this case, the elasticity of the vascular wall decreases and the functionality of the arteries is impaired.

Signs of atherosclerosis (affected areas are indicated by arrows) on MRI

Changes in lipid metabolism lead to the appearance of insoluble fats - cholesterol - in the blood. The substance is deposited on the walls of blood vessels in the form of spots, which over time thicken and grow with connective tissue. This process is called liposclerosis.

Cholesterol deposits gradually accumulate calcium salts. The plaque becomes hard and protrudes into the lumen of the vessel, deforming the wall at the site of attachment. Atherocalcinosis increases the risk of blood clots.

A cholesterol plaque narrows the lumen of the artery, disrupts blood flow, and causes ischemic phenomena in the tissues. In case of instability, separation of the pathological formation and obliteration (closure) of the vessel is possible.

The initial stage of the disease is asymptomatic. Signs of atherosclerosis in the later stages are ischemic and hemorrhagic phenomena in the brain (strokes) and heart muscle (heart attacks).

Factors contributing to the development of pathology include:

diabetes;
bad habits;
addiction to fatty, fried foods;
hypertension;
constant stress;
obesity;
physical inactivity;
hormonal changes during menopause (in women);
congenital predisposition.

A negative role in the development of atherosclerosis is played by dyslipidemia (a disorder of cholesterol metabolism) and damage to the inner layer of the walls of blood vessels.

If the carotid arteries are damaged, the patient is concerned about:

noise in ears;
minor vestibular disorders;
transient disturbances of vision, orientation in space;
unilateral paresthesia of the arms, legs, half of the face.

The patient may experience slight dizziness and short-term loss of balance.

MRA (magnetic resonance angiography) of the neck

Atherosclerosis of cerebral vessels is accompanied by fainting, convulsions, memory and speech disorders. The combination of these signs serves as the basis for prescribing MRI in order to identify pathologies of cerebral blood supply in the early stages.

Atherosclerotic lesion of the coronary vessels is accompanied by a clinical picture characteristic of coronary heart disease:

progressive shortness of breath;
pain and heaviness behind the sternum;
angina pectoris;
swelling of the lower extremities.

If the course of the disease is unfavorable, atherosclerosis leads to acute coronary insufficiency and death of the patient.

Damage to the vessels of the lower extremities is accompanied by intermittent claudication. Over time, pain in the legs becomes permanent, and trophic ulcers and gangrene may appear.

Early diagnosis of the pathological process helps to timely adjust nutrition, regulate metabolism in the body, and prevent the development of life-threatening complications. Treatment of the disease includes a set of therapeutic measures aimed at normalizing lipid metabolism. If necessary, surgical methods are used (balloon angioplasty, bypass surgery, etc.)

What does vascular atherosclerosis look like on an MRI image?

As a result of magnetic resonance imaging, the doctor receives monochrome images of thin sections of scanned tissue. The pitch thickness can be adjusted individually (minimum 1 mm). Layer-by-layer images are taken in three projections. Based on the obtained photos, a 3D model of the vascular system of the studied area is reconstructed.

Contrast enhancement used in MR angiography visualizes the structural features of the bloodstream. The advantage of scanning is the ability to assess the condition of the arterial network and surrounding tissues.

Signs of atherosclerosis on MRI images:

the presence of a characteristic thickening of the inner wall (intima-media complex);
narrowing of the lumen of the vessel;
there are no areas of signal loss due to the flow effect (a sign of severe stenosis or occlusion of the artery);
the presence of cholesterol formation (plaques);
the effect of “loss of flow” is possible - with stenosis over 95%);
signs of hemorrhage in case of rupture of the vascular wall;
symptoms of blood clot formation at the site of the lesion;
foci of necrosis, tissue ischemia due to impaired blood supply.

Fat-suppressed T1-weighted images show the composition of the cholesterol plaque. The photographs show hemorrhages, a necrotic core, and an increase in the amount of lipids in the thickness of the deposits. Thinning of the fibrous capsule of the plaque is possible (even to the point of rupture). Such formations are called “high risk” deposits.

Arterial stenosis and occlusion on MRI images

Spatial reconstruction of the network of blood vessels in atherosclerosis reflects changes in the lumen and disturbances in blood flow. Three-dimensional images make it possible to assess the localization of pathological deposits, the intensity of the process and the consequences of deterioration of blood circulation in the tissues.