Atherosclerosis and stroke

What is a Stroke? 

A Cerebrovascular accident (CVA) or stroke is a serious and life-threatening medical condition where cell death occurs when the blood supply to a part of the brain is cut off. The cells are deprived of oxygen. It happens when a blockage in an artery prevents blood from reaching cells in the brain (ischemic stroke), or an artery ruptures inside/outside the brain, causing a haemorrhage (hemorrhagic stroke).

What causes blood clots in the brain?

Ischemic stroke – occurs majorly across the general population. It is due to a thrombus or an embolus. A thrombus is a blood clot that is formed inside the blood vessel, whereas an embolus is a clot that is formed elsewhere and travels to the brain through the bloodstream.

The thrombus is usually formed around an atherosclerotic plaque. Atherosclerosis is an age-related degenerative disease of the blood vessels. 

An embolic stroke refers to an arterial embolism caused by a travelling unattached mass which is capable of creating blockages. When an embolus occludes a blood vessel, it is called an embolism or an embolic event. There are many number of different types of embolus, commonly a blood clot or a cholesterol plaque.

What are some of the risk factors for Atherosclerosis?

• Abnormal cholesterol levels  High blood pressure 
• Diabetes 
• Smoking 
• Obesity
• Family history 
• An unhealthy diet

Sometimes, ischemic strokes are preceded by symptoms called Transient Ischemic Attacks (TIAs) that can occur months before the stroke. It’s a warning sign for the patient as it shows that the person can be affected in the future. TIA is caused by a temporary blockage of a blood vessel and improves within a few minutes or hours.   

The most crucial modifiable risk factors for stroke are 

High blood pressure – Blood pressure of 140/90 or higher can damage blood vessels in the brain.

Heart disease – The second most important risk factor for stroke and the major cause of death among survivors of stroke. Heart disease and stroke have many common risk factors.

 Abnormal heart rhythm – Having an irregular heartbeat (atrial fibrillation) is the most common and treatable risk factor of stroke.

 Diabetes

 Smoking – It almost doubles your risk for an Ischemic stroke.

 Birth control pills (oral contraceptives)

 Dyslipidemia – High blood cholesterol and lipids 

 Sedentary lifestyle

 Overweight/Obesity

Excessive alcohol use

Toxic Drugs – Cocaine and certain other drugs have been closely linked to stroke

How to prevent blood clots in the brain?

• Positive lifestyle changes – Healthy diet, regular physical activity, quitting smoking and reducing alcohol intake.

• To keep a close eye on your blood pressure, sugar levels and cholesterol. 

• Normal body weight and low abdominal fat levels.

What is the treatment of blood clots in the brain?

• Definitive therapy within the first few hours aims at removing the blockage by breaking the clot down (thrombolysis), or removing it mechanically (thrombectomy). Thrombolysis in an AIS – Acute ischemic stroke is usually maximally effective when given within the first 3 hours of a stroke. The benefit is best when used earlier, hence recommended usage of the same within the same duration. 

• Endovascular therapy such as mechanical thrombectomy is a potential treatment for large vessel occlusion. It is usually done within the first 12 hours of the onset of stroke.

• Both thrombolysis and mechanical thrombectomy have been found to reduce disability rates.

• Aspirin reduces the risk of recurrence of stroke.

• Physical therapy plays a major role in the rehabilitation of disabled patients. 

Conclusion

The golden hour rule must always be followed for patients who have a high potential to go into stroke for the best possible outcome. Patients must not ignore the initial signs such as slurring of speech, weakness, numbness of limbs, etc. And must consult with a doctor or go to an ER as soon as possible.