Ten questions about stroke
(STROKE 10 Questions)
1.What is primary prevention and secondary prevention of stroke?
Primary prevention of stroke refers to the prevention before the disease occurs, that is, through early change of unhealthy life behavior, proactive control of various risk factors for disease, so as to achieve the purpose of cerebrovascular disease does not occur (or delay the onset of age). The so-called secondary prevention is for patients who already have stroke symptoms or after a stroke, and these people need to prevent the recurrence of stroke. In this case, in addition to continuing to control various risk factors, it is also necessary to prevent recurrence according to the different causes of stroke.
2. Is stroke preventable and treatable?
The answer is yes.
Stroke can be prevented. We need to correct the wrong concepts and unhealthy lifestyles, and consciously avoid the risk factors of stroke; in addition, we should pay attention to the pathological changes that have formed in the body, such as the stenosis caused by carotid plaque, and conduct regular stroke screening to detect the disease early, so that early diagnosis and early treatment can effectively prevent the occurrence of stroke.
After a stroke occurs, more than a certain amount of time (about 3 hours) brain tissue becomes necrotic and usually cannot be saved in an effective time. Studies show that less than 1% of patients (and probably less than 1 in 10,000 in China) are treated in time. Therefore, with timely treatment after a stroke, some patients can be completely relieved or even return to normal without any sequelae.
3.What are the screening tests for people at high risk of stroke?
General screening includes asking whether there are certain risk factors for stroke, including previous history of stroke, blood biochemistry, neurological examination, carotid ultrasound and transcranial Doppler examination (TCD). Special screenings include echocardiography, MRI, MRA, CTA, DSA.
4.Why should I check the carotid artery for stroke screening?
A stroke is a blockage in the brain artery, but doctors want to check the carotid artery for lesions, so why? The four carotid arteries (two carotid arteries in the front and two vertebral arteries in the back) that connect the heart to the brain arteries are the upstream arteries to the brain tissue and can be collectively called the carotid artery trunks. If the walls of one or more arteries in the carotid artery trunk have a lot of rust and scale (atherosclerosis) like an aging water pipe, then once the fragments of these plaques are dislodged, they will enter the cerebral arteries along the blood flow and cause blockage of the cerebral arteries. In addition, the official lumen of the carotid artery trunk narrows to a certain degree or is occluded, and its downstream (cerebral artery) will also suffer from cerebral ischemia or cerebral infarction because it does not get enough blood supply. Therefore, it is important for stroke patients to check their upstream carotid arteries for atherosclerotic plaques and their patency.
5.What tests can detect carotid artery stenosis?
General screening tests for carotid stenosis: carotid auscultation, ultrasound of carotid vessels, transcranial Doppler (TCD), CT angiography (CTA), magnetic resonance angiography (MRA) and whole brain angiography (DSA). The first three tests are non-invasive and can find out whether a patient has stenosis and the degree of stenosis in the carotid artery. The last test is invasive and is generally used for lesion confirmation and localization before surgery, and is the gold standard for diagnosing carotid artery stenosis.
6.Why do patients with transient ischemic attack (TIA) need imaging tests?
Since patients with transient ischemic attack (TIA) mostly improve completely after the symptoms last 10-15 minutes, leaving no clinical signs and symptoms, patients usually do not think it is necessary to have imaging examinations. However, since the probability of stroke is significantly higher in patients with TIA, the purpose of imaging can determine the cause of TIA, provide early treatment, and reduce the incidence of cerebral infarction. Cranial CT or MR examination can help to exclude intracranial lesions with similar manifestations to TIA; CTA or MRA can detect vascular stenosis and occlusion; CTP or MR cerebral perfusion examination can detect abnormal changes in cerebral blood perfusion in patients at an early stage. Therefore, imaging examination is of great value for the early diagnosis and timely treatment of TIA.
7.What is carotid endarterectomy (CEA)?
Carotid endarterectomy (CEA) is a surgical procedure to remove the atherosclerotic plaque blocked in the carotid artery. This procedure can improve or restore blood flow to the brain tissue in the ischemic area, which can help prevent stroke or relieve stroke symptoms.
Specifically, CEA is the removal of thickened carotid intima-media atherosclerotic plaque to restore blood supply to the brain, eliminate the source of emboli, and prevent strokes caused by plaque dislodgement. The procedure is relatively mature and has been performed for more than 50 years. Several international studies have confirmed the effectiveness of carotid endarterectomy. It is indicated for symptomatic patients with carotid stenosis >70% and asymptomatic patients with other risk conditions and carotid stenosis >60%.
8.Who is suitable for carotid endarterectomy?
Patients who have already had a stroke, or those who have had a transient stroke (TIA), such as sudden limb weakness or haziness that lasts for a short time, or those who have not yet had any stroke symptoms, are suitable for carotid endarterectomy if the examination reveals a carotid artery stenosis of 70-99%.
9.Which is better, carotid endarterectomy (CEA) or carotid stenting (CAS)?
Both CEA and CAS are excellent methods for restoring blood flow to the carotid artery, and both have their advantages and disadvantages. In general, CEA is preferred when the stenotic lesion is located in a surgically accessible area in the extracranial segment, and CAS should be considered in the following cases: (1) when the stenotic lesion is located higher in the neck; (2) when the stenotic lesion is located in the intracranial segment and cannot be reached by surgical means; (3) when the lesion is located in a surgically accessible area but the patient has a severe combined clinical condition that cannot tolerate surgery; (4) when restenosis occurs after CEA.
10.Is CEA surgery safe?
As with any surgery, there are certain risks and complications associated with CEA, which vary from person to person. However, with the advancement of technology and the improvement of surgeons, the risk of the procedure can be controlled to a minimum and is therefore relatively safe.