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Carotid artery disease – a major risk factor of ischemic stroke

If you experience sudden loss of vision, numbness or weakness on one side of the face or body, difficulty walking or lack of limb coordination, sudden dizziness, difficulty in speaking and swallowing and sudden headaches, you may have the symptoms of transient ischemic attacks (TIA) which could progress to a major stroke. These symptoms may at first, last only a few minutes or a few hours and then be resolved. When they occur, get yourself to see a doctor immediately.
A TIA happens when there is only a minimal amount of blood flows to part of the brain. This happens when plaque or a clot builds up in an artery that supplies blood to the brain. Carotid arteries that supply blood to most of the brain are located each side of the neck. Each carotid artery is divided into two major branches, the external and the internal carotid artery.
  1. The external carotid artery supplies blood to the face and skull.
  2. The internal carotid artery supplies blood to the brain.
Over a period of time, plaque may develop in these arteries particularly in those at high risk, including those who are obese or smoker, who suffer from hypertension, diabetes, high cholesterol or have a family history of heart problems when they are young. This is called carotid artery disease.
In some cases, clots may also form on plaque. If a piece of plaque or a clot breaks off or emboli, it can enter the blood vessel to the brain. The result is an ischemic stroke which can cause brain damage leading to serious disability or death.
Dr. Kosin Thupvong, Director of Cardio-Thoracic surgery at Bangkok Heart Hospital, explained the cause and symptoms of strokes and medical procedures required after experiencing a stroke.
Strokes are called “brain attacks” because oxygen and blood-flow to part of the brain is cut off. Over 80 percent of all strokes are ischemic, caused by a small clot that blocks an artery in the brain, stopping blood flow. The other less than 20 percent of strokes are hemorrhagic, caused by bleeding in the brain. If blood flow is not restored, impairment can result, including loss of brain function, speech, vision, movement (paralysis) and even death. Time is of the essence with anyone who shows signs of a stroke. The quicker they get to hospital the more successful the medical treatment is likely to be.
To diagnosis carotid artery disease should start with the doctor listen to the arteries in the neck with a stethoscope. An abnormal rushing sound, called a bruit, may indicate carotid artery disease. However, bruits are not always present when they are blockages and may be heard even when the blockage in minor.
At Bangkok Hospital, we recommend a diagnostic test using Doppler ultrasound to send high frequency sound waves to check whether or not arteries build up plaque. It is a very inexpensive and a non-invasive technique.
We may implement either a CAT scan, an MRI or the latest Digital Subtraction Angiography (DSA) technology, a 3-dimensional X-ray, in order to look very precisely at the arteries, prior to performing surgery or intervention treatment.
Carotid endarterectomy is the most common treatment of severe artery disease. The procedure is performed either under either local or general anesthesia. After making an incision along the front of the neck, the surgeon opens the affected carotid artery and removes the plaque. The artery is repaired with either stitches or a graft. Studies have shown that the surgery is low risk in most healthy people and has lasting benefits in terms of stroke prevention.
Carotid angioplasty and stenting is recommended when the location of the narrowing or blockage is too difficult for the surgeon to access directly, or the patient has health conditions that make surgery too risky. A local anesthetic is applied to the patient prior to the process being performed. After this, a tiny balloon is threaded by catheter into the area where the carotid artery is clogged. The balloon is inflated to widen the artery and a small wire-mesh coil, known as a stent, is inserted to keep the artery from narrowing again.
Because carotid artery disease usually not cause any symptom until the diaease is far advance. As such, regular physical check-ups and diagnostic tests are required for people at high risk from the age of about 45 and up.
No one wants to experience a stroke. The key is to stop it happening in the first place by changing one’s lifestyle, including  quitting smoking, controlling high blood pressure, cholesterol, diabetes and heart and having regular check-ups. Also, limit alcohol intake, consume foods low in saturated fats and sodium and exercise regularly. 
If you comply with these guidelines, you will get stronger and healthier and most importantly you won’t need a hospital to become your second home.