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Preventing Strokes from Carotid Artery Disease
Paul R. Johnson, M.D.
Stroke is the third leading cause of death in the United States each year. The incidence of new stroke is approximately 160 per 100,000 population per year. When a stroke occurs, the physical and emotional trauma is devastating, and quality of life can be severely compromised.
A significant proportion of strokes may result from arterial stenotic disease of the two main blood vessels in the neck. These critical blood vessels, called the carotid arteries supply the major majority of blood flow to the brain. Hardening of these arteries can reduce the flow of oxygen. In addition, irregular placques exposed to the high pressure flow of arterial blood may break off and shower the brain with particulate matter composed of platelets, cholesterol, and calcific debris.
Any and all of these events can produce "mini strokes" called transient ischemic attacks (TIAs). Symptoms of TIAs consist of a temporary black curtain like blindness in one eye or temporary paralysis of an arm or leg with or without numbness. Occasionally, reversible slurring of speech, brief passing out, or acute clumsiness of hand or foot may occur.
The risk of stroke after a "TIA" may be higher than 10%. Similarly, the risk of a repeat stroke during the first year is also about 10%. The stroke rate from silent, asymptomatic carotid artery tightness is also of clinical concern and is dependent upon the degree of tightness.
Significant disease of the carotid arteries which may lead to the development of stroke is easily and painlessly detected by a non-invasive vascular study called carotid duplex. This entails an ultrasound examination of the carotid arteries which shows both the tightness of the arterial disease and its impact on the restriction of blood flow. In addition, irregular, ulcerative placques can be seen.
The primary objective for of surgery for carotid artery disease is the prevention of stroke. When surgically significant tightness of the carotid artery is detected, the artery can be cleared of its stenotic or ulcerative placque disease. Carotid surgery (endarterectomy) can be performed either under general or local anesthesia with deep sedation. Most patients are discharged the following morning. Discomfort is minimal and responds well to oral pain medication.
The post-operative stroke (complication rate) has been less than 1%. The clinical impact of carotid endarterectomy is currently being evaluated, but the overall result appears to be a reduction in both rate of stroke and death from strokes. Thus, many strokes can be prevented, and screening carotid duplex examinations appear to be very beneficial.