Stroke, Mini Stroke, Transient Ischaemic Attack (TIA)

A stroke or mini stroke is a result of damage to brain tissue which can be from lack of blood supply. Symptoms can include weakness down one side of the body (hemiparesis), slurred speech, visual disturbance with sudden loss of vision in one eye, facial droop on one side, confusion and cognitive impairment. The most common causes of stroke include blockage of blood supply (through atherosclerotic plaque or blood clot) and bleeding in the brain.

Stroke from atherosclerotic plaque most commonly affects the older population. Like peripheral disease, the most common risk factors and associations for cerebrovascular atherosclerotic disease include:

• High blood pressure (hypertension)
• Diabetes
• Heart disease (ischaemic heart disease, heart attack, angina)
• High cholesterol levels (hypercholesterolaemia)
• Smoking
• Family history
• Poor diet/lifestyle

Narrowing and blockage of the carotid arteries in the neck is a condition that most commonly does not cause symptoms (asymptomatic), and on the other hand can cause a serious stroke with life threatening consequences. Unfortunately in most cases, the narrowing or blockage in the carotid artery remains asymptomatic until the stroke or mini stroke occurs.

The right and left carotid arteries are located in the neck, and supply blood to the brain in conjunction with other arteries (vertebral arteries). The narrowing or blockage is caused by atherosclerotic plaque in the carotid artery. The more significant the narrowing, the greater the risk of plaque breaking off and traveling up the artery (embolisation) causing a sudden blockage in one of the small arteries of the brain causing a stroke or mini stroke.

Symptoms of stroke can include weakness down one side of the body (hemiparesis), slurred speech, visual disturbance with sudden loss of vision in one eye, facial droop on one side and confusion.

Symptoms can be temporary and completely resolve within 24 hours (mini stroke or transient ischaemic attack or TIA), or can persist beyond 24 hours and become permanent (stroke). If you develop these symptoms it is advisable that you seek medical attention as soon as possible as treatment of TIA and stroke can be time critical.

At Yarra Vascular Surgeons we take cerebrovascular atherosclerotic disease very seriously. For patients who have had a stroke or TIA, we consider surgical intervention if there is significant carotid artery narrowing. In certain circumstances it is advisable to treat a blocked carotid artery to reduce your risk of having a TIA or stroke even though you may not have had symptoms. Clearing out the blockage or narrowing (endarterectomy) is performed with open surgery however depending on the circumstances, generally in patients with unfavourable anatomy or high anaesthetic risk, we have access to minimally invasive carotid stenting.

After a carotid artery has been operated on or stented, we ensure the intervention remains optimised with regular follow up appointments and surveillance ultrasound scans to monitor the repair. We strive to ensure that any procedure we have performed is durable and remains optimised through regular surveillance both clinically and with ultrasound scanning. Medical management through risk factor optimisation and modification including blood thinning medication, treatment of blood pressure and cholesterol levels, diabetes control, and smoking cessation is also a vital part of our treatment approach to cerebrovascular atherosclerotic disease and we regularly involve specialists in these areas to participate in your overall care.

Once you are a patient with Yarra Vascular Surgeons we develop a lifelong clinical relationship, ensuring that we do our best to ensure that all aspects of your vascular health remains optimised.