Prevention of stroke
By Dr. V Balaji
Stroke,
otherwise called ”brain attack” is a potentially life threatening condition.
It affects tens of thousands of people a year across the world. In addition
to being fatal in some cases it can be quite incapacitating. It affects the
family emotionally and also affects national economy due to loss of
potential working hours.
Louis Pasteur, Lenin and the man who authorised Hitler to form the cabinet Marshal Paul von Hindenburg all died of it. In the US at least 10 presidents have suffered from or died of this condition Woodrow Wilson, Franklin Roosevelt, Eishenower are example.
Stroke is mainly caused because of bleeding in the brain or a sudden block in blood supply to a part of the brain commonly affecting the area which controls body movements. Bleeding inside the brain usually occurs in patients with high blood pressure. This can be prevented or at least the chances can be minimised by controlling blood pressure. Reduction inn blood supply to the brain occurs due to hardening of the blood vessels to the brain (internal carotid artery). It usually happens in the neck where it branches off from the main artery of the neck (common carotid artery).
Patients who are at high risk of developing this problem are those with high blood pressure, high cholesterol problems and smokers. These patients sometimes present with premonitory symptoms like intermittent blindness (Amaurosis Fugax) or a minor or minor stroke before having a full attack.
It is possible to prevent the occurrence of this stroke by a surgical procedure called carotid endarterectomy.
Prior to surgery the hardness can be assessed by various techniques. One which is easily performed and commonly used is a sophisticated scan called Duplex scan which is much similar to ultrasound scan. This scan gives the amount of blood flowing through the artery. If the artery is found to be significantly narrowed the patient will then benefit from surgery.
Studies
In the prevention of strokes, studies in North America and Europe have shown that surgery gives better results than treatment with Aspirin alone. There is seven or eight fold reduction in the incidence of stroke in the patients who underwent surgery. Obviously, this major surgery is not without complications. However they are well within acceptable limits when performed by a good vascular surgeon.
This procedure can also be done in asymptomatic patients when they are picked up during regular medical check up when arteries of both sides of the neck are significantly narrowed or before having a heart bypass operations (as the risk of developing stroke is increased due to fluctuations in blood pressure). The role of this surgery in completely a symptomatic patients is controversial. Even though it is widely practised in North America recent studies from England do not favour this.
The operation involves exposing the main artery of the neck along with its branches. After obtaining control over the circulation the diseased part is opened and the narrowing is corrected.
Post operative recovery is usually smooth even though close monitoring is essential. In most cases the patient will be able to go home on the third day after the operation. The wound also heals very quickly leaving only a thin scar which becomes hardly visible after a few months.
Even after the operation it is essential to control the blood pressure, Aspirin tablets and a low fat diet will have to be continued. Smoking should be avoided strictly. Even though this surgery has been widely and commonly practised in Western countries in many Third World countries not many patients are being offered to undergo this procedure.
It is certain that with this procedure, a stroke and its consequences can be avoided.