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Strokes kill more people in Thailand than heart attacks. Despite the high prevalence of deadly strokes in men older than 60. Annual check-ups starting in middle age can uncover warning signs that help high-risk individuals enjoy longer, happier lives.

STROKES are now the third leading cause of death in Thailand, superseding coronary diseases and trailing only cancer and accidents. They occur when a buildup of arterial plaque blocks the carotid arteries that supply oxygen-rich blood to the brain. Just like the plaque that gathers around the heart, arterial plaque in the carotid pathways is a mixture of fat, cholesterol, white blood cells and calcium deposits. This helps explain why one-fifth of patients with coronary disease have plaque buildup in their carotid arteries as well.

“High-risk patients should get annual check-ups once they turn 45, even though most patients who are operated on are around 60, and the majority of patients are men,” says Dr. Kosin Thupvong, cardiothoracic surgeon and senior director of the Bangkok Heart Hospital.

According to Dr. Kosin, individuals who are overweight, smoke have high cholesterol, hypertension, diabetes and coronary diseases have a particularly high risk of suffering a stroke. Family history also plays a large role in determining the probability of an episode later in life.

The first step to detecting plaque building is an ultrasound scan. If the results are positive, a magnetic resonance angiography (MRA) or computed tomography angiography (CTA) reveals the degree and location of the blockage. Even if the buildup does not block a pathway completely, a small piece of plaque can still break loose and travel through the bloodstream to other organs, causing hemorrhages. Excessive plaque accumulation can cause an arterial rupture leading to clots and restricted blood flow.

In a worst-case scenario, strokes cause death and paralysis. Approximately 80 percent of patients experience at least partial paralysis. If the patient’s symptoms dissipate within 24 hours, the episode is classified as a “mini-stroke”, or transient ischemic attack (TIA). One-third of TIA victims suffer partial paralysis. Symptoms of a TIA include an immobilized tongue, twisted mouth, trouble swallowing, slurred speech, blurred vision, weakened limbs, headache and dizziness.

After a stroke occurs, there are two surgical treatments available. The first, carotid angioplasty, inserts a small metal stent into the blocked pathway to prevent further plaque buildup. In severe cases, when more than 70 percent of the artery is blocked, a carotid endarterectomy (CEA) is performed to remove the plaque entirely.

Operations are only done when the entire plaque buildup can be completely removed,” explains Dr. Kosin. “Partial removal can accidentally dislodge remaining plaque in the future.”

The condition becomes inoperable if the plaque buildup extends beyond the jawline. In such cases, the carotid artery on the other side of the neck will supply sufficient blood to the brain to keep the patient alive, but eyesight on the blocked side of the head may be lost.

Up to 15 percent of patients experience a second attack sometime in their lives if they do not change their health habits. Taking preventive measures early on can help high-risk patients to lead longer, happier lives.