Stroke is the fourth leading cause of death and the leading cause of long-term disability in the United States. About 25 percent of strokes are due to buildup of a fatty substance called plaque in the carotid arteries, the two major vessels that take blood to the brain. When pieces of plaque break off and travel to the brain, blood flow is cut off and a stroke may occur.
Symptoms of stroke usually include sudden weakness or numbness on one side, trouble speaking or sudden vision loss in one eye. Occasionally, signs and symptoms of stroke may go away on their own in a short time. This is due to a resumption of blood flow due to the body’s own defenses and is referred to as a transient ischemic attack or TIA, an event that serves as a warning of impending stroke.
Call 911 if you or a loved one shows any signs or symptoms suspicious for stroke or TIA. Stroke treatment not only includes medicines but measures to open up the diseased artery with either surgery to remove plaque, or stenting, a procedure that opens up the vessel with a small metal tube.
Since most strokes from the carotid arteries occur in patients who have had no prior symptoms, doctors have tried to predict individuals at risk before symptoms occur. The best way to assess carotid arteries in these patients is with a carotid artery ultrasound, a simple test to detect plaque and assess its severity.
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This test is not recommended for routine screening of patients without symptoms. It does appear reasonable, however, to recommend ultrasound in patients with two or more of the following risk factors: high blood pressure, high cholesterol, tobacco smoking or a family history of stroke or heart attack before the age of 60 years.
If severe plaque is noted in a person without any history or symptoms of stroke, the patient should be treated with aspirin and a cholesterol-lowering drug. High blood pressure and diabetes, if present, also should be treated, and smoking cessation is a must.
The current best option for patients found to have severe but asymptomatic plaque buildup after medications would be to enroll in a North American clinical trial called CREST 2. This trial is designed to determine whether or not medicines alone are sufficient treatment to prevent stroke or whether carotid surgery or stenting would provide further benefit. Complete information on the trial, including participating locations, may be found online at Crest2trial.org.
Dr. Michael Jones, an interventional cardiologist with Baptist Health Medical Group Lexington Cardiology, practices at Baptist Health Lexington.