Stroke, Mini Stroke and Carotid Artery Disease

A stroke, often referred to as a ‘brain attack,’ is a medical emergency that can have serious consequences.

A mini-stroke, also known as a ‘transient ischemic attack’ (TIA), is a warning sign of a future potential stroke.

Carotid artery disease increases the risk of both stroke and TIA.

A stroke occurs when there is a disruption in the blood and oxygen supply to the brain, causing damage to brain cells. Brain cells are very sensitive to a lack of oxygen and they can die as a result.

There are two main types of strokes:
A stroke can be caused by a blood clot (ischemic stroke) or a ruptured blood vessel (haemorrhagic stroke). Ischemic strokes are the most common, accounting for around 87% of all strokes.

A haemorrhagic stroke occurs when a blood vessel in the brain ruptures, causing blood to leak into the surrounding brain tissue. This can result in increased pressure and damage to the brain.

A mini-stroke or TIA, is a brief episode with stroke-like symptoms that typically lasts for a few minutes to a few hours. Although the symptoms of a TIA are temporary and resolve on their own, they shouldn’t be ignored as they are a warning sign of future stroke.

The causes of strokes and mini-strokes are closely related, as both involve the disruption of blood flow to the brain. The primary risk factors for these conditions include:

The primary cause of carotid artery disease is atherosclerosis, a condition where fatty deposits, cholesterol, and other substances (called plaque) accumulate on the inner walls of the arteries. Over time, these deposits can rupture and potentially lead to a stroke or TIA. Other risk factors for carotid artery disease are the same as those for stroke.

Recognising the symptoms of a stroke or mini-stroke is crucial for seeking prompt medical attention. The common symptoms for both conditions include:

In the case of a mini-stroke (TIA), the symptoms are similar but temporary, usually lasting between a few minutes and a few hours. They shouldn’t be ignored, as they may precede a full-blown stroke.

If carotid artery disease is in its early stages, you may not have any symptoms. Your doctor may notice a sound called a ‘bruit’ when checking your pulse. This faint sound is a distinctive sign of a carotid artery blockage.

As the blockage increases, the most common first sign may be a mini-stroke. For some people, a stroke is the first sign of any problem with the carotid artery.

Diagnosing stroke and mini-stroke usually involves a combination of medical history, physical examination, and diagnostic tests. Common diagnostic procedures include:

• Physical examination: Your doctor will assess your brain function, paying close attention to any signs of stroke.
  
• Imaging: Various imaging tests can help identify the type, location, and extent of any brain damage. These tests may include computed tomography (CT) scans, magnetic resonance imaging (MRI), and angiography.
  
• Blood tests will help determine your cholesterol levels, blood sugar, and clotting factors.
  
• Electrocardiogram (ECG): An ECG can identify irregular heart rhythms, such as atrial fibrillation, which may contribute to stroke risk.
  
• Carotid ultrasound: This non-invasive test uses sound waves to create images of the carotid arteries, allowing your doctor to assess the extent of plaque build-up in the arteries.

Diagnosing carotid artery disease involves assessing the health of the carotid arteries and the extent of blockages. Common diagnostic tests include:

Effective treatment for stroke or mini-stroke depends on several factors, including the type of stroke, the underlying cause, and the time since the onset of symptoms. Common treatments may include:

If you have had an ischaemic stroke, or you’ve been diagnosed with carotid artery disease several drugs can be used:

• Clot-busting drugs (thrombolytics) can be administered to dissolve blood clots in ischemic strokes.
  
• Antiplatelet drugs, such as aspirin, are prescribed to prevent blood clots in these conditions
  
• Anticoagulants may be used to thin the blood and reduce the risk of blood clot formation.

• Rehabilitation: After a stroke, rehabilitation therapy, including physical, occupational, and speech therapy, can help you to regain lost functions and improve your quality of life.
  
• Lifestyle Changes: Managing risk factors such as high blood pressure, diabetes, and high cholesterol is crucial in preventing recurrent strokes. This often involves dietary changes, exercise, and stopping smoking.

After an ischaemic stroke, your doctor may recommend a surgical procedure to remove blood clots in your brain:

Dr Theivendran performs two types of surgical intervention for carotid artery disease aimed at preventing strokes by opening a narrowed or blocked carotid artery: