Stroke is one of the most feared and deadlies illnesses in America today. Luckily, many strokes can be prevented and today even treated, especially if related to carotid artery disease.

What is a Stroke?
A stroke occurs if te blood flow to part of your brain is interrupted. This may occur because of a little bit of clot blocking a blood vessel(artery) in your brain or because of decreased blood flow to your brain because of a narrowed blood vessel. Sometime a blood vessel in your brain burst because of high blood pressure and a stroke can occur. Less common causes include tumors in your brain, AV malformations, or trauma.

Symptoms of a Stroke or Mini-stroke (TIA)
-Sudden weakness or numbness of the face, arms or legs, particularly on one
  side of the body
-Loss of speech or trouble understanding speech
-Sudden unexplained memory loss
-Sudden dimness or loss of vision in one eye
-Double vision
-Sudden severe, acute headache
-Dizziness or loss of balance/gait

If any of the above occur to you or a loved one for even a few minutes, immediate medical attention should be sought. Some treatments of stroke only work if they patient can be treated within a couple of hours. If the symptoms go away in a few minutes or even hours, then a mini-stroke or TIA (transient ischemic attack) may have occurred. If the symptoms last longer than a day, then a real stroke may have occurred.

Risk factors for stroke

Controllable:

• High blood pressure
• Tobacco use
• High cholesterol
• Obesity/overweight
• Physical inactivity
• Diabetes
• Atrial fibrillation (irregular heartbeat)
• Unhealthy diet
• Cardiac disease
• Carotid artery disease

Uncontrollable:

• Age
• Gender
• Family history
• Race

Carotid artery disease can contribute to up to 40% of all strokes.

How can carotid artery disease cause a stroke?
When a carotid artery is diseased, the inside of the artery develops a fatty substance called plaque to build up on it. The artery is narrowed by this plaque and can become rough and calcified. Because of the narrowing, less blood can flow through to the brain and this can prevent some parts of your brain from getting enough oxygen to work normally. Tiny bits of this irregular plaque can also break off to form emboli that can enter small blood vessels in your brain and prevent blood from getting to those parts of the brain. That part of the brain can die without the blood flow it needs. That is a stroke.

How can carotid disease be diagnosed?
Many people with carotid problems are discovered on routine physical examination by their primary doctors before they have a proble. The doctor listens to their carotid arteries in their neck with a stethoscope and hears a whoosing sound called a bruit. This is something not normally heard and can be caused by plaque build up in the artery. The next step is to get an ultrasound. This can painless look at the arteries with sound waves and is the main way of determining whether there is anything to be concerned about. Occasionally, if the plaque is very calcified (and the sound waves can’t “see” through it) or if further information is needed and MRA (magnetic resonance angiogram) or regular angiogram may be obtained.

How is carotid disease treated?
Based on the findings of the above tests as well as the presence or absence of symptoms of stroke, you may or may not need surgery. Everyone with carotid disease should be on an anti-platelet agent such as aspirin. One baby aspirin a day has been found to be sufficient to significantly decrease the risk of stroke with carotid disease. If the artery is narrowed more than 60% and you have symptoms or more than 80% and you don’t have symptoms, you may be a candidate for surgery. There are two options for intervention today.

Carotid Endarterectomy: This is the standard treatment of carotid disease. It has been clearly shown to greatly decrease the risk of stroke when done properly as compared to medical therapy alone. It involves an incision in the neck through which the carotid artery is found and controlled with clamps. The artery is then opened, after blood thinning medication has been given and the plaque is removed by using a small scoop or spatula. The artery is then sewn back up. Most patients go to the intensive care unit overnight and are discharged the following day. Complications associated with the surgery include stroke, heart attack, irregular heart rhythms, bleeding, and temporary nerve problems such as hoarseness or neck numbness.

Carotid stenting is a brand new procedure that has just been approved by the FDA for use in high risk patients with carotid disease who have had a stroke or TIA. It is done by introducing a thin tube through an artery in the groin and then delivering a metal mesh stent up to the area of the diseased artery. Often a balloon is also used to angioplasty the area. Tnis allows the area of narrowing to be opened up and the bits of plaque to be trapped beneat the stent. Risks of this also include stroke, heart problems, and bleeding at the puncture site in the groin.

Risk Assessment

• Do you have high blood pressure or do you take medication for high blood pressure?
• Do you smoke or have a long history of smoking?
• Do you have an irregular heartbeat?
• Do you have have high cholesterol or do you take medication for high cholesterol?
• Is there an immediate family history of stroke or heart disease? (mother, father, siblings, children)
• Do you exercise less than three times per week for 20-30 minutes at a time?
• Do you eat a diet high in saturated and/or animal fat?
• Are you over 55 years of age?
• Are you male?

If you have checked Yes for two (2) or more of the above risk factors, you may be a candidate for a Stroke/Carotid Artery Screening and/or a Peripheral Arterial Disease Screening.