Prevent your next stroke—or your first stroke—with TCAR
A little blood clot can do a lot of damage – especially when it goes to the brain, that’s called a stroke. Virginia is part of the “Stroke Belt” because of its unusually high rates of stroke and cardiovascular disease, likely due to high rates of tobacco use, obesity and genetic factors. Many strokes are caused by narrowing in the carotid arteries which are located on both sides of the neck. A stroke can be very serious, leading to death or disability and we need to treat it just as seriously as we do heart attacks. That starts by looking at where clots form – in the carotid arteries. There are many options for prevention and treatment of strokes caused by carotid disease and Dr. Rasesh Shah from Sentara Vascular Specialists explains a few of them.
“Preventing strokes starts with screening at the primary care level, looking at stroke risks like blocked or narrowed carotid arteries and other vascular problems. Each year, the risks accumulate, especially for people with cardiovascular diseases,” Shah said.
Who is at risk?
According to the American Stroke Association, the likelihood of having a stroke nearly doubles every 10 years after age 55. For people with known heart disease, the risk can be up to 25 percent higher and for those known to have peripheral artery disease (the narrowing of blood vessels in your arm and leg muscles) risks can be up to 50 percent higher.
Physicians recommend that high-risk patients take these steps to avoid stroke:
- Stop smoking
- Control your blood pressure
- Take an anti-platelet or anti-coagulant medication
- Take a cholesterol medication like a statin
These types of interventions are generally instituted before most people see a specialist like Dr. Shah, and primary care physicians may also do an ultrasound of the arteries to look at how narrow they have become. Lower your risks if you can through healthier choices, but also look at medical interventions that may help lower your risk.
How can I prevent a stroke?
Once arterial plaque buildup is located, one option is an endarterectomy, a surgery where the plaque is removed by a vascular surgeon after opening the artery with a scalpel. That can be invasive, due to the need to open up the artery, so stents have gained popularity as an option. Inserting a stent into the carotid artery widens the vessel, increases blood flow, and prevents clots from breaking off and going to the brain, a helpful option for preventing strokes. Most of these stents are inserted from a puncture in the femoral artery in the groin.
But Dr. Shah believes we’ll see a shift towards a new option that combines the benefits of both, called Trans Carotid Artery Revascularization, or TCAR. Invasive surgery (Carotid Endarterectomy) and stent insertion from the femoral artery are both very good procedures, but both have their own set of potential complications.
TCAR has the benefits of a more invasive endarterectomy, including lower stroke rates, without the disadvantages of transfemoral stenting, which is less invasive but carries a higher stroke risk.
What are my options?
Options for prevention and treatment of stroke should be discussed with your physician, taking into account factors like medical history, risks of complications, age and overall health. Signs of a stroke include numbness in arms or legs, facial muscle weakness and speech impairment. One reason that strokes are overlooked is that they can include one or more symptoms, and may also include other less obvious symptoms such as double vision, coordination problems, headache or confusion – so people may not realize they are having a stroke if the symptoms are less obvious.
“The same way that most people know that chest pain may mean a heart attack, we need to educate people that a brain attack is just as important. The damage from overlooking or ignoring symptoms can be severe. Every minute means more brain cells lost during a stroke” Shah said.
If you are at risk for strokes, see your physician and ask for ways that you can prevent your first (or next) stroke. There are options and your physician can walk you through the choices to select the one that’s best for you.
About the Author:
Dr. Rasesh Shah is a board-certified vascular surgeon with Sentara Vascular Specialists, specializing in carotid endarterectomy, carotid stents, and TCAR. He is available for consultation by appointment at 757-395-1600.