Strokes are among the most frightening medical problems because they are common, unpredictable, strike suddenly without warning, and often are deadly.
Unlike other serious conditions such as heart disease, there has never been a reliable diagnostic test that can reveal who is a likely candidate for one of these “brain attacks.”
Now that is changing.
Carotid artery disease, a condition in which plaque builds up inside the carotid arteries that supply blood to the brain, causes more than half the strokes in the U.S., according to the National Heart, Lung, and Blood Institute.
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In recent years, new techniques have been developed to identify who’s at risk and to treat carotid artery blockages before a stroke occurs.
“The interventions we have are continually improving and can help prevent future strokes,” says Paul Crisostomo, M.D., a vascular and endovascular surgeon at the Loyola University Medical Center in Maywood, Illinois.
One of the best ways to detect carotid artery disease is with an ultrasound scan, a painless, noninvasive test. Using a probe that sends sound waves into the neck and a computer that translates the effects into images that can be seen on a screen, the test can gauge the speed of blood flow through the carotid arteries, anatomic images of the arteries, and a sense of how narrow the arteries are and how much plaque is present.
These factors give “us a very important clue as to whether there’s a blockage,” says Dr. Crisostomo.
Doctors typically reserve this scan for people over 50 who have a family history of cardiovascular disease or peripheral vascular disease, or symptoms of a transient ischemic attack (often called a mini-stroke) such as sudden weakness or numbness on one side of the body, trouble speaking, or sudden vision problems, dizziness, or loss of balance. However, if you don’t fit any of these categories but are worried about having a stroke, your physician might agree to give you this test if you request it.
A less-involved alternative is to ask your doctor to simply listen to your carotid arteries with a stethoscope during a physical exam. If a whooshing sound called a “bruit” is found – a sign of blockage – the ultrasound scan can then be performed, notes Paul Lucas, M.D., a vascular surgeon and director of the vascular laboratory at Mercy Medical Center in Baltimore.
Other tests that can detect carotid blockages include a carotid angiogram (in which contrast dye is injected into a vein that travels to the carotid arteries and produces images of the arteries on an X-ray or CT scan), or a magnetic resonance imaging (MRI) scan if there’s a lingering question about the results of an ultrasound or another screening test.
“If the person is asymptomatic and the carotid artery is 70 percent blocked, we might consider surgery,” says Dr. Lucas. “If the person is symptomatic, we’d consider doing surgery with a blockage less than that.”
While medications (such as aspirin, antiplatelet drugs, and statins) can help stabilize carotid artery disease, they can’t get rid of blockages, Dr. Crisostomo says. Only surgery can do that.
With a carotid endarterectomy, which carries less than a 2 percent risk of stroke, a surgeon opens the carotid artery and removes plaque and the artery’s inner lining. With a newer procedure called carotid artery stenting, a surgeon places a stent in the blocked artery to open it and restore blood flow.
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“This carries a slightly higher risk of stroke,” Dr. Crisostomo notes. “When it comes to stroke, every little bit matters to us because compared to a heart attack, a stroke can be much more debilitating.”
Ultimately, your best bet is to discuss your risk factors for carotid artery disease with your doctor to decide if you need testing, says Dr. Crisostomo.
The complete version of this article first appeared in Health Radar. To read more, CLICK HERE.
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