Stenosis Explained

Stenosis is the abnormal narrowing of a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture).^[3]

Stricture as a term is usually used when narrowing is caused by contraction of smooth muscle (e.g. achalasia, Prinzmetal angina); stenosis is usually used when narrowing is caused by lesion that reduces the space of lumen (e.g. atherosclerosis).^[4] The term coarctation is another synonym, but is commonly used only in the context of aortic coarctation.^{[5] [6]}

Restenosis is the recurrence of stenosis after a procedure.^[7]

Examples

Examples of vascular stenotic lesions include:

• Intermittent claudication (peripheral artery stenosis)
• Angina (coronary artery stenosis)
• Carotid artery stenosis which predispose to (strokes and transient ischemic episodes)^[8]
• Renal artery stenosis

Types

Vascular Stenosis

Arterial stenosis

• Carotid artery stenosis
  • • Coronary artery stenosis Renal artery stenosis Peripheral artery stenosis
• Vertebral artery stenosis
• Cerebral artery stenosis
• Pulmonary artery stenosis
  • Congenital or acquired abnormal narrowing of pulmonary arteries along any portion of the pulmonary artery tree

Venous stenosis

• Jugular venous stenosis
• Central venous stenosis

Cardiac Valve Stenosis

In order from most to least common:

• Aortic valve stenosis
  • Normal aortic valves are estimated to be less than a millimeter thick.^[9] Subsequent fibrosis and calcification of the valve leads to narrowing of the valve and therefore decreased blood flow out of the heart.
• Mitral valve stenosis
  • thickening of the mitral valve (of the left heart), therefore causing narrowing
• Tricuspid valve stenosis
  • thickening of the tricuspid valve (of the right heart), therefore causing narrowing
• Pulmonary valve stenosis
  • thickening of the pulmonary valve, therefore causing narrowing

Neurologic/Spine Stenosis

• Spinal canal stenosis
  • Cervical spinal stenosis
  • Thoracic stenosis
  • Lumbar stenosis
• Foraminal stenosis
• Aqueductal stenosis

Gastrointestinal Stenosis

• Esophageal stenosis
  • A congenital or acquired fixed narrowing of the esophagus.^[10]
    • Congenital subtypes
      • Tracheobronchial remnants
      • Fibromuscular thickening / fibromuscular stenosis
      • Membranous webbing or esophageal membrane
    • Acquired ^[11]
      • Injury (example: swallowing button battery ^[12])
      • Gastroesophageal reflux disease (GERD)
      • Eosinophilic esophagitis (EoE)
        • Achalasia Pyloric stenosis (infantile hypertrophic pyloric stenosis)
  • Relatively uncommon disorder of infants, usually between the ages of 2–12 weeks, caused by abnormal thickening of the pylorus muscle in the stomach at the junction between the end of the stomach and the beginning of the duodenum.^[13]
• Small-bowel stenosis
• Colonic stenosis (bowel obstruction)
• Anal stricture
• Rectal stricture

Respiratory Stenosis

• Subglottic stenosis
  • Congenital or acquired narrowing of airway diameter in anatomic area below the vocal cords.^[14]
• Laryngotracheal stenosis
• Bronchial stenosis

Genitourinary Stenosis

• Ureteral stenosis
• Urethral stenosis
• Cervical canal stenosis
• Meatal stenosis
• Vaginal stenosis
  • Abnormal shortening or tightening of the vaginal canal.^[15]

Others

• Biliary duct stenosis

Causes

• Alcohol
• Atherosclerosis
• Birth defects
• Calcification
• Diabetes
• Headbanging
• Iatrogenic
• Infection
• Inflammation
• Ischemia
• Neoplasm
• Smoking
• Ureteral
• Urethral

Diagnosis

Stenoses of the vascular type are often associated with unusual blood sounds resulting from turbulent flow over the narrowed blood vessel. This sound can be made audible by a stethoscope, but diagnosis is generally made or confirmed with some form of medical imaging (such as ultrasound).^[16]

See also

• Atresia

External links

• Web site: Tracheal Stenosis Audio and Video. https://web.archive.org/web/20070112051244/http://homepage.mac.com/changcy/voicebreathing.htm . dead . 2007-01-12 .
• Web site: Symptoms of Urethral Stricture . 20 May 2011 . en . https://web.archive.org/web/20160717174226/http://www.uretra.it/sintomi-generici-pazienti/?lang=en . July 17, 2016 . live.

Notes and References

1. OED 2nd edition, 1989, as pronounced as //stɪˈnəʊsɪs//.
2. Web site: Definition of STENOSIS. 2023-02-16. www.merriam-webster.com. en.
3. Web site: Dorlands Medical Dictionary:stenosis . www.mercksource.com . 2010-05-05 .
4. Web site: Atherosclerosis - What Is Atherosclerosis? . National Heart, Lung, and Blood Institute . 24 March 2022 .
5. News: Coarctation of the Aorta (CoA) . American Heart Association .
6. Groenemeijer . B. E. . Bakker . A. . Slis . H. W. . Waalewijn . R. A. . Heijmen . R. H. . An unexpected finding late after repair of coarctation of the aorta . Netherlands Heart Journal . July 2008 . 16 . 7 . 260–263 . 10.1007/bf03086158 . 18711614 . 2516290 .
7. Web site: Forgos . Richard N. . August 2004 . Restenosis After Angioplasty and Stenting . About.com Health .
8. Web site: Carotid Artery Stenosis . The Lecturio Medical Concept Library . 15 March 2021 . 6 July 2021.
9. Goody . Philip Roger . Hosen . Mohammed Rabiul . Christmann . Dominik . Niepmann . Sven Thomas . Zietzer . Andreas . Adam . Matti . Bönner . Florian . Zimmer . Sebastian . Nickenig . Georg . Jansen . Felix . April 2020 . Aortic Valve Stenosis . Arteriosclerosis, Thrombosis, and Vascular Biology . 40 . 4 . 885–900 . 10.1161/ATVBAHA.119.313067 . 32160774 .
10. Brzački . Vesna . Mladenović . Bojan . Jeremić . Ljiljana . Živanović . Dragoljub . Govedarović . Nenad . Dimić . Dragan . Golubović . Mladjan . Stoičkov . Viktor . November 2019 . Congenital esophageal stenosis: a rare malformation of the foregut . Nagoya Journal of Medical Science . 81 . 4 . 535–547 . 10.18999/nagjms.81.4.535 . 2186-3326 . 6892676 . 31849372 .
11. Collins . Margaret H. . Alexander . Eileen S. . Martin . Lisa J. . Grotjan . Tommie M. . Mukkada . Vincent A. . Sheil . Amy . Abonia . Juan P. . Putnam . Philip E. . Rothenberg . Marc E. . 2022 . Acquired Esophageal Strictures in Children: Morphometric and Immunohistochemical Analyses . Pediatric and Developmental Pathology. 25 . 2 . 124–133 . 10.1177/10935266211041086 . 1615-5742 . 10102868 . 34515576.
12. Leinwand . Kristina . Brumbaugh . David E. . Kramer . Robert E. . January 2016 . Button Battery Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions . Gastrointestinal Endoscopy Clinics of North America . 26 . 1 . 99–118 . 10.1016/j.giec.2015.08.003 . 1558-1950 . 5425245 . 26616899.
13. Li . Annie . Bhurawala . Habib . October 2021 . Pyloric stenosis in an infant . Australian Journal of General Practice . 50 . 10 . 744–746 . 10.31128/AJGP-10-20-5667 . 2208-7958 . 34590095.
14. Hanlon . Katherine . Boesch . R. Paul . Jacobs . Ian . April 2018 . Subglottic Stenosis . Current Problems in Pediatric and Adolescent Health Care . 48 . 4 . 129–135 . 10.1016/j.cppeds.2018.03.007 . 1538-3199 . 29801771.
15. Morris . Lucinda . Do . Viet . Chard . Jennifer . Brand . Alison H. . 2017 . Radiation-induced vaginal stenosis: current perspectives . International Journal of Women's Health . 9 . 273–279 . 10.2147/IJWH.S106796 . free . 1179-1411 . 5422455 . 28496367.
16. Takekawa . Hidehiro . Tsukui . Daisuke . Kobayasi . Saro . Suzuki . Keisuke . Hamaguchi . Hirotoshi . Ultrasound diagnosis of carotid artery stenosis and occlusion . Journal of Medical Ultrasonics . October 2022 . 49 . 4 . 675–687 . 10.1007/s10396-022-01259-7 . 36175716 . 252622616 .