Atherosclerosis of the carotid and vertebral arteries may cause dizziness, headache, fainting, impaired coordination of movements. The patient has slurred speech, short-term vision problems. Also, these signs are characteristic of atherosclerosis of cerebral vessels.

The formation of a complicated atherosclerotic plaque occurs as a result of the progression of the process. There is a significant increase in the lipid core, increased aggregation (gluing) of platelets, development of hemorrhages in the plaque, thinning of its fibrous capsule, and destruction of the plaque cover with the formation of cracks, tears, and atherosclerotic ulcers. On the basis of ulcers, blood clots form, and later - atherocalcinosis (deposition of calcium salts in atheromatous masses, plaque structure). The main consequence of the formation of a complicated atherosclerotic plaque is the formation of a wall thrombus, which suddenly and sharply limits the blood flow in the artery. Atherosclerosis of brachiocephalic arteries (BCA) threatens with ischemic stroke (brain infarction).

What precedes atherosclerosis?

There are risk factors for this disease. Atherosclerosis develops as a result of:

• smoking
• arterial hypertension (systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg)
• carbohydrate metabolism disorders (hyperglycemia, diabetes)
• adiposity
• hyperhomocysteinemia
• dyslipidemia (increased content of certain cholesterol fractions in the blood)
• unhealthy diet (consuming a lot of fats and carbohydrates)
• sedentary lifestyle (hypodynamia)
• frequent stresses
• hereditary predisposition

Age (people over 50–60 years old) and male gender are also risk factors.

Factors such as smoking, hypodynamia, and eating habits are related to lifestyle: they can be modified (subject to correction). Modifiable risk factors include high blood pressure, type 2 diabetes, and dyslipidemia. Age, male gender and heredity are unmodified risk factors.
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Conservative. Optimal drug therapy is possible if stenosis at the plaque level is < 60% and has not manifested itself in any way (asymptomatic course):

• there are no ischemic foci according to MRI or MSCT of the brain in the basin of the artery affected by atherosclerosis
• there was no episode of neurological deficit (transient ischemic attack) that would correspond to a violation of the blood supply to the area of the brain that receives blood from the basin of the artery stenosed by an atherosclerotic plaque
• Absence of characteristic features of a complicated atherosclerotic plaque according to the data of the conducted examinations. The presence of atherosclerotic ulcers and signs of plaque destruction even with small stenoses is an indication of pre-endovascular stenting or carotid endarterectomy (surgical removal of the plaque)

During cold plasma vaporization, destruction and removal of the excess part of the nucleus pulposus occurs. After the procedure, the intradisc pressure decreases, the fibrous ring due to its elastic properties "retracts" into its previous position, the hernia "reduces" and stops pressing on such structures as nerve roots and the spinal cord. Vaporization removal of a hernia (nucleoplasty) is one of the most modern options for its treatment.

ADVANTAGES OF NUCLEOPLASTICS

• A minimally invasive procedure, with high accuracy due to the use of X-ray control
• No need for general anesthesia
• Absence of complications that may arise as a result of open surgery
• Outpatient procedure does not require hospitalization, the patient can go home on the same day
• Duration - up to 60 minutes
• Fast recovery time
• Most patients experience rapid relief of symptoms and gradual improvement over the next 2 weeks

INDICATIONS FOR NUCLEOPLASTY

• According to the results of the examination, the presence of a protrusion or minor herniation of the intervertebral disc in the patient while maintaining the integrity of the fibrous ring
• Discogenic pain syndrome in the cervical or lumbar regions of the spine
• Root syndrome in the presence of disc protrusion
• Failure of conservative treatment for several weeks

HOW LONG DOES THE PROCEDURE TAKE?

The total time of the procedure is usually from 15 minutes to 1 hour.

WHAT HAPPENS AFTER THE PROCEDURE?

Patients should remain under observation for 1-2 hours after the procedure and limit movement during the first day. Then the patient is discharged home. After the procedure for 1-3 days, you should avoid prolonged sitting and gradually increase the load by walking. On the recommendation of the doctor, it is also necessary to limit for a while:

• Physical activity
• Sexual relations
• Sports activities (football, basketball, tennis or any other activity that can potentially cause stress on the operated intervertebral disc).

WHAT IS THE EFFICIENCY OF THE PROCEDURE?

In most cases, the symptoms caused by intervertebral hernia or disc protrusion are reduced in two stages: a rapid early improvement immediately after the procedure and a delayed improvement for several weeks after the procedure due to the restoration of collagen fibers.

COMPLICATIONS AFTER NUCLEOPLASTY?

This is a relatively new and safe procedure, with an evidence base of more than 2 million treated patients as of 2022. According to the results of the studies available today, no serious complications were found.