Stroke the #2 killer.I wasn't thrilled about the statistics of direct surgery, an endarterectomy. Depending on the expertise of the doctor, the mortality (you croak) is (shudder) between one and (gasp) four percent . . . the morbidity, which includes inducing a stroke, is much higher.
THE SECOND LEADING CAUSE OF DEATH The brain is made up of billions of nerve cells. It controls our ability to see, hear, taste, and smell and to move our arms and legs. Thought, emotion, memory, judgment, and awareness also originate in the brain. Blood provides a continuous supply of oxygen and nutrients to the brain, primarily through four major blood vessels. The two largest are the right and left carotid arteries. They can be easily felt next to the trachea or windpipe. The two smaller blood vessels, the vertebral arteries, provide oxygen and nutrients to the base of the brain, the part of the brain that maintains respiration, heartbeat, and body temperature. When the blood supply to any portion of the brain is interrupted, the nerve cells that do not receive oxygen-rich blood die. The injury to the brain that results from such an interruption is called a stroke, or, as the National Stroke Association states - a "Brain Attack". The extent and location of the brain cell damage determine the severity of the stroke, which can range from minimal to catastrophic. Because different areas of the brain control different functions, the specific effects of a particular stroke depend on which area of the brain is injured. A small stroke in a critical area can be disastrous. Because brain cells do not regenerate, damage to those nerve cells is permanent. Stroke is now the second leading cause of death in the United States. Survivors of stroke have varying degrees of a disability from dimentia to total incapacity to return to work. Stroke rehabilitation focuses on facilitating return to function. In addition to teaching compensatory techniques, rehabilitation programs help patients and families adjust to the effects of stroke. Stroke or "Brain Attack" is widely misunderstood. Many people do not realize that strokes are predictable. In fact health-care providers can often tell which people are at risk for stroke. Strokes are also preventable and treatable. Learning about the risk factors and seeking prompt treatment are important actions to take. Causes: The causes of stroke are classified into two broad groups: ischemic (about 85% of strokes) and hemorrhagic (about 15% of strokes). Ischemic strokes are further broken down into four categories: Thrombotic - Blood flow to the brain is blocked by a blood clot (thrombus) in a large carotid artery previously damaged by atherosclerosis. In atherosclerosis, calcium and cholesterol accumulate on the inside of a blood vessel, narrowing or blocking the artery; these deposits are called plaque. Blood clots form readily along the rough surface of the plaque, obstructing the already- limited flow of blood. About 60% of strokes are the result of this mechanism. Embolic - Blood flow is blocked by a clot that formed elsewhere in the cardiovascular system, usually the heart. A piece of loose plaque or a clot (embolus) is carried through the bloodstream and lodges in a small artery, causing a stroke. Lacunar - A tiny artery in the brain is completely blocked by plaque. While the area of damage may be very small, the severity of the stroke could be significant, depending on which part of the brain is injured. Blood clotting abnormality - Abnormalities in the chemistry of the blood and the blood cells result in increased clot formation. This cause of stroke is rare. In a hemorrhagic stroke, a weakened blood vessel ruptures and blood escapes into the brain. This mass of blood presses on the normal brain tissue, destroying a portion of it in the process. Uncontrolled high blood pressure is the usual cause. Transient Ischemic Attack (TIA) A TIA, or mini stroke, is a kind of ischemic stroke. Symptoms last a few minutes or hours and then disappear. Always report a TIA to a doctor. It is often a sign that a more damaging stroke is on the way. Seek treatment right away, even if symptoms go away quickly. Signs and Symptoms of a Stroke or Brain Attack Sudden numbness or weakness of the face, arm or leg, especially on one side of the body Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination These symptoms signal a medical emergency! It is vital to seek emergency medical care at once - call 911. Every minute counts! The majority of patients do not report to the emergency room until 24 hours after the onset of stroke symptoms. The longer the delay in patient presentation, the more damage a stroke can do and the less recovery can be achieved. Remember: Brain is time, evaluation of the patient in less than 3 hours from onset of signs and symptoms is optimal. Risk Factors for Stroke Some people are more likely than others to have a stroke: Older people Men African Americans Diabetics People who have already had a stroke We have no control over the above risk factors. However, other factors that increase the risk of stroke can be treated: high blood pressure, heart disease, and peripheral vascular disease. Making changes in lifestyle to control high blood cholesterol, cigarette smoking, excessive alcohol intake, and obesity can also reduce the risk of stroke. Diagnosis of Cerebrovascular Disease Determining whether a person has significant cerebrovascular disease requires a number of steps. A neurological and general physical examination will be taken first. As part of the history, the doctor will need to know which, if any, risk factors for stroke the patient has: high blood pressure, diabetes, oral contraceptive use, heredity, irregular heartbeat, other heart diseases, smoking, diet (especially high sodium and high cholesterol), lack of exercise, obesity, blood disorders, and heavy alcohol consumption. High blood pressure is the leading cause of stroke. A detailed physical examination evaluating the heart, the blood vessels, and the nervous system in addition to specialized tests will help determine whether other conditions might be causing the symptoms. Of particular importance is the non invasive duplex evaluation of the carotid arteries: Doppler ultrasound - a microphone-like device placed on the neck uses sound waves to measure blood flow. Ultrasound imaging - a small probe placed on the neck uses high- frequency sound waves (ultrasound) to create an image of the artery and its interior, which is projected on a video screen. Both of these tests are completely painless; no needles, dyes, or x- rays are used. They can be performed quickly, in about ten minutes, and hospitalization is unnecessary. If the examination, test results, and symptoms point to carotid artery disease, the patient may have an angiogram, an x-ray test in which dye is injected into the arteries leading to the brain. This shows the exact location of narrowing, blockage, or other defect. Risk Reduction Through Treatment Medication. If the disease is mild, medication may decrease the risk of stroke. Drugs that slow the clotting of blood or prevent the formation of clots may be used. Medications that help control diabetes, heart disease, hypertension, and cholesterol may be prescribed. Surgery. Vascular surgery is intended to prevent a stroke by removing plaque that obstructs flow of blood to the brain. Carotid endarterectomy is the most common vascular surgery in the United States and may reduce the risk of stroke by as much as 55%. Carotid arteries are the major contributor to the most common type of stroke, thrombotic. Following a carotid endarterectomy, very few arteries become obstructed again, although they may become narrowed over time. This procedure is safe and effective if done by a highly trained doctor.. The Future New treatments of carotid artery and cerebrovascular disease include placement of clot dissolving medications directly into the blood vessels in the brain. Placement of vascular stents in carotid arteries, vertebral arteries and even some of the smaller blood vessels in the brain is a treatment available at some stroke centers. In accordance with recommendations from the National Stroke Association many communities are establishing standards for hospitals that have "Stroke Centers." Stroke Centers will have the latest in treatments available and will help to gather data about the many new medications being studied today that may reduce the occurrence and the severity of stroke. Medical evaluation, treatment, and changes in lifestyle to reduce risk factors of stroke are essential. These changes include exercising, adopting a healthy diet, controlling blood pressure and weight, lowering cholesterol levels in the blood, and not smoking. Making these changes in lifestyle may slow the progression of cardiovascular and cerebrovascular disease. It is critical for everyone to "Be Stroke Smart" and learn the three R's of stroke; Reduce risk, Recognize symptoms, Respond by calling 911. If you want further information, or have been told you need an endarterectomy by your local cardiologist, I would contact one of the centers below. Both do the non-surgical stenting which appears to be much safer than direct surgery . . . provided you are a suitable candidate.
Arizona heart center
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