DEFINITION

Cerebrovascular disease is the second biggest cause of cardiovascular deaths and is a disease that affects the arteries responsible for supplying blood to the brain, especially carotid and vertebral arteries. These arteries are more frequently affected by atherosclerosis with the progressive reduction of the size of the vessel by plaques. These lesions can progress to complete occlusion of the vessel (thrombosis) or may fragment, giving rise to embolic phenomena that can lead to occlusion of smaller vessels. Embolic phenomena can also come from other locations such as the heart. In both cases the result is the reduction or cessation of blood flow in certain segments of the brain. Consequences of such events vary depending on the extent and importance of the affected brain tissue. The clinical overview may be different and the patient may have sensory disorders (sudden blindness in one eye, tingling and/or loss of feeling in a limb) or motor disorders (loss of strength in one limb or half of the body, deviation of the buccal fissure, clumsiness with speech, difficulty in writing). The aspect that distinguishes such events is the abrupt onset, which often captures the patient in full well-being and which may manifest itself transiently or permanently.

•  TIA (transient ischaemic attack)

Is a type of reversible cerebral ischaemia. This clinical manifestation should not be underestimated at all, as it can only be a prelude to a much more serious event, namely a stroke.

•  ICTUS (stroke)

Differs from TIA in its irreversibility. It should be stressed that cerebrovascular disease can cause the death or disability of the patient with serious clinical and socio-economic consequences for the patient themselves, their family and society as a whole. The task of treatment, whether medical or surgical, is to prevent such events from occurring (asymptomatic patient) or from occurring again with sometimes fatal consequences (symptomatic patient). The cornerstone of medical therapy is based on the fact that by making the blood more fluid with various devices (antiaggregants, anticoagulants) we try to reduce the likelihood of such events occurring. Medical therapy is advisable if cerebrovascular disease affects small cerebral vessels that cannot be treated by surgery or by unimportant carotid and/or vertebral stenosis. Surgery occurs when the stenosis of the extracranial arteries (carotids and/or vertebral arteries) are greater than 60-70%, in the case of “at risk” plaques (soft, with a low calcific and fibrous component) which, because of their more crumbly conformation, are at risk of causing embolic or thrombotic phenomena or, in urgent cases and in selected cases, when acute events occur in order to limit the extent of the neurological ischemic event. Before subjecting the patient to surgery, it is also necessary to balance the risk/benefit ratio considering the age and the life expectancy of the patient, the state and the functions of all the organs and apparatuses, with particular attention to the renal, cardiac, cerebral and respiratory ones. Therefore, the decision whether or not to correct a stenosis of the extracranial arteries takes place after the evaluation of the characteristics of the lesion itself and through all the investigations necessary to discover or, in any case, better assess the general health status of the patient. This involves not only the surgeon but also other professionals. If, at the end of the diagnostic procedure, the patient is not considered suitable for surgical treatment, monitoring the stenosis itself is recommended, by means of investigations such as the ecocolordoppler to be performed at intervals defined by the specialist, being attentive to any new symptoms that may be a warning of the evolution of the disease. Therefore, if there is an indication for surgical/endovascular treatment, different methods of treatment can be used.