Changes inside the blood vessels often occur as a result of nicotine abuse, long-term diabetes, or dietary factors. Over time, these deposits and changes in the walls cause the blood vessels to narrow progressively—leading to atherosclerosis and what is known as arterial stenosis (“narrowing of the arteries”).
The result: circulatory disorders, e.g., in the brain or kidneys, as well as an increased risk of heart attack.
Changes inside the blood vessels often occur as a result of nicotine abuse, long-term diabetes, or dietary factors. Over time, these deposits and changes in the walls cause the blood vessels to narrow progressively—leading to atherosclerosis and what is known as arterial stenosis (“narrowing of the arteries”).
The result: circulatory disorders, e.g., in the brain or kidneys, as well as an increased risk of heart attack.
What is arterial stenosis?
Stenosis generally describes the narrowing of a blood vessel; arterial stenosis, therefore, refers to the narrowing of an artery. It is important to note that, particularly in large vessels, a slowly progressive narrowing can remain asymptomatic for a long time. In contrast, smaller arteries—such as those found in the brain or kidneys—are affected by stenosis much more rapidly.
Arterial stenosis © pankajstock123 #63446706 | AdobeStock
What causes arterial stenosis?
The main cause of stenosis is atherosclerosis, commonly known as hardening of the arteries. Deposits of cholesterol, fatty acids, and calcium lead to hardening and thickening of the affected blood vessels. The artery becomes increasingly narrowed and loses elasticity.
According to current knowledge, the main risk factors for atherosclerotic vascular changes are
- smoking,
- high blood pressure (hypertension),
- obesity,
- elevated blood lipid levels,
- high cholesterol levels,
- diabetes,
- stress, and
- an unhealthy diet.
In addition, genetic factors also appear to play a role.
What are the key symptoms?
As mentioned at the beginning, larger vessels with a wider cross-section in particular can remain asymptomatic for a long time despite developing arterial stenosis, as is the case with aortic stenosis, for example.
In the case of the often very fine arteries and capillaries in the kidneys and brain, however, complete occlusion of the vessel can occur relatively quickly—in the kidney, doctors refer to this as a renal infarction; in the brain, it is a stroke.
The symptoms therefore depend primarily on which artery is affected by the narrowing.
Arterial stenosis in the kidneys is primarily detected indirectly through treatment-resistant high blood pressure. Levels of substances normally excreted in the urine also rise in the blood. In addition, patients may experience palpitations and headaches. In the brain, depending on the severity of the arterial stenosis, various neurological deficits may become apparent, such as paralysis, speech, vision, or sensory disturbances. In severe cases, arterial stenosis in the brain can even lead to a coma or death.
Diagnosis: How do doctors detect arterial stenosis?
The simplest method is auscultation (listening with a stethoscope) of the kidneys, during which the flow noises caused by turbulence in the affected arteries become audible.
To reliably confirm or rule out arterial stenosis, doctors use various imaging techniques.
In addition, Doppler ultrasound (duplex sonography) is used to visualize blood flow patterns, for example, in the renal vessels. For the kidneys and brain, it is also possible to visualize even the smallest arteries using CT (computed tomography) or MRI (magnetic resonance imaging) angiography in order to precisely locate narrowings (stenoses). This is important for planning further treatment based on the imaging results.
How are arterial stenoses treated?
In the case of renal artery stenosis, medication—particularly for high blood pressure—may be tried as a first-line treatment. However, depending on the degree of blockage in the affected blood vessel, invasive therapy—surgery—is usually the next step.
Doctors distinguish between two different surgical approaches:
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First, percutaneous transluminal angioplasty, in which a stent is inserted into the narrowed vessel during the procedure. A stent is a thin wire mesh that stabilizes the narrowed section of the artery and keeps it open. If the vessel is narrowed by more than 60%, doctors generally prefer stent surgery.
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On the other hand, it is also possible to bypass the narrowed vessel. In medical terms, this is known as bypass surgery. However, this procedure is increasingly being phased out in favor of stenting and is now rarely performed.
In cases of arterial stenosis in the brain, a stent is implanted in a similar manner.
Stent placement is now a safe and successful procedure. In 95% of patients, the procedure typically eliminates the narrowing, for example, in the renal artery. In half of all patients, high blood pressure also decreases after the arterial stenosis has been corrected.
Arterial narrowing and treatment with a stent © crevis #89836026 | AdobeStock
Can arterial stenosis be prevented?
If the arterial stenosis is genetic—that is, inherited—there is nothing that can be done to prevent it.
However, the risk of atherosclerosis—which is usually the cause of arterial stenosis—can be effectively reduced through a healthy lifestyle and by avoiding stress.
Which specialists treat arterial stenosis?
Arterial stenosis is a vascular disease that is primarily treated by specialists in vascular and cardiovascular medicine—angiologists and cardiologists. You can find suitable centers and doctors in your area via the following link.
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