Surgery Is Not the Answer for Preventing All Strokes
Among the strokes counted in the study, a third had causes other than blockages in the carotid arteries. Smaller blood vessels were the cause in 20%, while 10% came from blood clots that originated in the heart and then became lodged in the brain. Among the patients who previously had surgery, the researchers found that up to 45% of their strokes did not occur in areas where the vessels had been clogged. Among the strokes related to the heart, many were caused by an irregular heart rhythm, called atrial fibrillation, which is easily treatable with medication.
"We hope that people will pay attention to their patients and make sure they are not the sort of patient who needs treatment of the heart and things that will cause small vessel disease -- hypertension, diabetes, and high cholesterol," Barnett says. "If they have never had any symptoms at all, by all means just don't think about the arteries in the neck."
In an editorial accompanying the study, Louis R. Caplan, MD, argues that its findings underscore the need for thorough evaluations of patients who are at risk for stroke. "The main message of this article is that many patients have more than one potential cause of stroke. Doctors should try to identify all potential causes and treat those that can be treated," Caplan tells WebMD. "Don't necessarily stop the investigation when one suspect is found." Caplan is a neurologist at Beth Israel Deaconess Medical Center in Boston and professor of neurology at Harvard Medical School.
This research was supported by the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.
- Surgeons can clean out clogged blood vessels in the neck to prevent a stroke, but a third of strokes are unrelated to these arteries.
- Some experts are worried about ultrasounds that are advertised to examine these particular vessels, even though there are many other important factors in determining stroke risk.
- Physicians should try to identify all potential causes of stroke and treat those that can be treated.