Stenosis of Carotid Arteries by Homocysteine: It’s Role in Neurological Events

Review Article

Austin J Cerebrovasc Dis & Stroke. 2020; 7(1): 1084.

Stenosis of Carotid Arteries by Homocysteine: It’s Role in Neurological Events

Cacciapuoti F*

Department of Internal Medicine, “L. Vanvitelli” Campania University, Naples, Italy

*Corresponding author: Federico Cacciapuoti, Internal Medicine Department, “L. Vanvitelli” Campania University, Piazza L. Miraglia, 80131, Naples, Italy

Received: April 19, 2020; Accepted: June 23, 2020; Published: June 30, 2020


Hyperhomocysteinemia (HHcy) was previously identified as a risk factor for atherosclerosis. In this study we evaluated the relationship between HHcy and carotid-artery stenosis and its role in inducing some neurological accidents. Several mechanisms exist, through increased homocysteine (Hcy) levels cause atherosclerosis of carotid arteries’ vessels. In turn, atherosclerosis frequently involves supra-aortic trunk (SAT), especially common carotid artery (CCA) and internal carotid artery (ICA), causing carotid plaques. Vulnerability of carotid plaques can yield intracerebral vascular events by thrombo-embolic mechanisms. That most frequently happens when HHcy is contemporary present in association with some common diseases, independently of atherosclerotic lesions of Willis circle vessels. Therapeutically for the primary prevention of plaques’ disruption and cerebral accidents, statin treatment and vitamins B supplementation have demonstrated to significantly reduce the frequency of both. On the contrary, these treatments for secondary prevention are uncertain and further studies are requested.

Keywords: Homocysteine; Carotid-artery atherosclerosis; TIA; Ischemic stroke


High homocysteine (HHcy) serum levels are associated with different vascular disease [1], such as coronary artery disease, ischemic stroke and peripheral artery disease [2,3] as carotid-artery disease [4- 6]. Concerning that, data from several studies suggest that mild HHcy is a risk factor for stenosis and/or occlusion of carotid-arteries both in men and women, frequently yielding some intracerebral vascular accidents [7-11].

Anatomically, three branches arise from the superior border of aortic arch: brachiocephalic trunk (BCT), left common carotid artery (CCA) and left subclavian artery carotid (SCA). In turn, BTC later divides into right CCA and in right SCA. At bifurcation, Common carotid artery (CCA) of each side, at bifurcation divides in two parts: external (ECA) and intracranial carotid artery (ICA) (Figure 1). ECA provides blood flow supply to the scalp, face and neck, while ICA supplies blood to the brain. CCA presents an extracerebral share only. On the contrary, ICA divides in extracranial and intracranial tract. This last begins at the base of the skull and penetrates into the brain. Atherosclerotic process causes stenosis/occlusion of CCA or ICA through the plaques’ organization. The possible disruption of these could bring on disturbed intracranial arterial hemodynamics due to an artery-to-artery embolism or chronic hypoperfusion [12].