Giant Cell Arteritis: Symptoms, Treatment, Causes, Mortality, Prognosis, and Management

Definition of Carotid Arteritis

Carotid arteritis (Carotid Arteritis) is an inflammatory disease affecting large blood vessels, including the carotid artery, and is mainly classified as a large vessel vasculitis. The carotid artery is a crucial blood vessel supplying blood to the brain; inflammation in this vessel can affect cerebral blood flow, leading to severe complications. Carotid arteritis causes thickening of the blood vessel walls due to inflammation, hindering blood flow and manifesting in various symptoms. Representative vasculitis diseases includeTakayasu arteritis(Takayasu arteritis) andGiant Cell Arteritis(Giant Cell Arteritis), which can cause inflammation in large blood vessels, including the carotid artery.

Characteristics of Carotid Arteritis

The most significant characteristic of carotid arteritis is inflammation in large blood vessels, including the carotid artery. This inflammation causes changes in the blood vessel walls, potentially narrowing or blocking them, reducing blood flow and resulting in various symptoms. The main characteristics of carotid arteritis are as follows:

1. Inflammatory vasculitis: Carotid arteritis is a vascular inflammatory disease that can damage the blood vessel walls. This causes the vessels to thicken or narrow, and in severe cases, there is a risk of blockage or rupture.

2. Reduced cerebral blood flow: Because the carotid artery is the main blood vessel to the brain, inflammation in the carotid artery reduces blood flow to the brain. This can lead to stroke or temporary blockage of blood flow to the brain.

3. Occurs in various age groups: Carotid arteritis can occur mainly inyoung womenorelderly people over 50. Giant cell arteritis, a specific disease, mainly occurs in elderly people over 50, while Takayasu arteritis is more common in young women.

4. Large vessel inflammation: Carotid arteritis can cause inflammation not only in the carotid artery but also in the aorta and large vessels extending to the elbow and below the clavicle. This can reduce vascular function and cause problems with blood circulation.

Causes of Carotid Arteritis

1. Autoimmune response

• One of the main causes of carotid arteritis is anautoimmune response. In autoimmune diseases, the immune system attacks its own tissues. When the walls of large blood vessels, including the carotid artery, are attacked by immune cells, inflammation occurs. This inflammation causes changes in the blood vessel walls over time, hindering blood flow.

2. Genetic factors

• Carotid arteritis can be caused by genetic factors. Some studies have shown that family history or gene mutations may affect the development of carotid arteritis. In particular,HLA-B27and other specific genes may be involved.

3. Environmental factors

• Environmental factors can also influence the onset of carotid arteritis. Infections or environmental stimuli can stimulate the immune system, triggering an autoimmune response. Studies suggest that some infections can be a trigger for the development of carotid arteritis.

4. Hormonal factors

• Carotid arteritis tends to occur more frequently inwomen. This is because hormonal changes, particularlyestrogen, may affect the immune response. Takayasu arteritis occurs frequently in young women, which may be related to female hormones.

5. Other diseases

• Vasculitisand other vascular diseases can cause carotid arteritis. Also,aortitisand other inflammatory diseases can affect the carotid artery.

Symptoms of Carotid Arteritis

1. Neck pain and pressure: Inflammation in the carotid artery can cause neck pain or pressure. The neck may swell if the inflammation is severe.

2. Headache: Changes in cerebral blood flow due to carotid arteritis can cause headaches. These headaches are usually temporary and not persistent, but in severe cases, they can lead to a serious stroke.

3. Dizziness: If carotid arteritis becomes severe, reducing blood flow to the brain, dizziness may occur. Dizziness may be triggered by standing up or sudden movements.

4. Visual impairment: Reduced blood flow to the brain can cause blurred vision or vision loss. This is because the area of the brain responsible for vision does not receive sufficient blood supply.

5. Elbow or arm pain and weakness: Carotid arteritis affects not only the carotid artery but also large vessels related to the aorta. This can cause pain or weakness in the elbows, shoulders, and arms.

6. Fatigue and weight loss: Chronic inflammation can cause fatigue and weight loss due to the ongoing effect of the inflammation on the body.

7. Auscultatory sound in the head and neck vessels: In carotid arteritis, inflammation of the blood vessel walls can cause abnormal changes in blood flow. This can result in an auscultatory sound in the head and neck vessels.

Diagnosis of Carotid Arteritis

1. Physical examination: A physical examination is performed to check for inflammation in the carotid artery, whether the blood vessel is thickened or swollen, and the presence of pain.

2. Blood tests: Blood tests check for inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to confirm the presence of inflammation. Specific antibody tests to check for autoimmune diseases may also be necessary.

3. Ultrasound examination: Carotid ultrasound can assess blood vessel thickness and blood flow. Ultrasound is non-invasive and quick to perform, making it useful in the diagnosis of carotid arteritis.

4. CT or MRI angiography: CT or MRI angiography can identify inflammation and stenosis in blood vessels related to the carotid artery. It is particularly useful for observing subtle changes in blood vessels.

5. Angiography: Angiography is a method of visually confirming stenosis and changes due to inflammation by injecting a contrast agent into a blood vessel. This method allows for accurate assessment of the blood vessel's condition.

Treatment and Surgical Methods for Carotid Arteritis

Treatment for carotid arteritis focuses on alleviating inflammation and restoring normal blood flow. Treatment methods are broadly divided intomedicationandsurgical treatment.

1. Medication

• Steroids: High doses of steroid medication may be used to suppress inflammation in carotid arteritis. Steroids quickly alleviate inflammation and prevent blood vessel wall thickening.
• Immunosuppressants: If an autoimmune disease is the cause, immunosuppressants are used to suppress the immune system's overreaction. Representative drugs includemethotrexate (MTX)andazathioprine (Azathioprine).
• Anti-inflammatory drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce inflammation and pain.
• Antiplatelet agents: If carotid arteritis becomes severe, there is a risk of thrombus formation; antiplatelet agents or anticoagulants can prevent thrombus formation.

2. Surgical treatment

• Vascular reconstruction surgery: If the carotid artery is severely narrowed or blocked due to carotid arteritis, vascular reconstruction surgery can widen the narrowed area or treat the blocked area.
• Stent placement: Astentcan be inserted to widen a narrowed blood vessel. The stent supports the inner wall of the blood vessel, facilitating smooth blood flow.
• Arterial bypass surgery: If a blood vessel is severely blocked or at risk of rupture, arterial bypass surgery can divert blood flow through another route.

Prognosis and Management of Carotid Arteritis

The prognosis of carotid arteritis depends on the timing and appropriateness of treatment. With appropriate treatment to control inflammation and restore normal blood flow, a good prognosis can be expected. However, if inflammation persists for a long time, vascular changes occur, and serious complications can arise.

Management methods

• Regular checkups: Carotid arteritis requires ongoing management. Regular vascular examinations monitor the state of inflammation and blood vessels, enabling continued necessary treatment.
• Continued medication: Medication to control inflammation may need to be continued long-term. Medications should be taken regularly as directed by a physician.
• Maintaining a healthy lifestyle: Regular exercise and a balanced diet are essential to maintaining vascular health. Smoking cessation and moderate alcohol consumption also benefit vascular health.