Britta Schmeis, dpa
Strokes follow close behind cancer and heart disease among the main causes of death in the developed world.According to the German association for assisting stroke patients, 85 per cent of cases result from poor blood flow to the brain. This is frequently caused by hardening of the arteries, or arteriosclerosis. "The two carotid arteries supply the brain with blood, dividing it over smaller blood vessels," says Martin Grond, a German neurology professor. Calcification, or the depositing of a variety of substances like cholesterol, tissue, blood cells and calcium salts, could lead to a reduction in the amount of blood flowing to the brain. This is not necessarily dangerous, as other arteries can make up the shortfall. "However, the second problem is that the narrowing results in greater pressure arising in the obstructed artery that can send calcium particles shooting into the brain, where they block the smaller blood vessels," Grond says. "This may result in a stroke." "Deposits in the blood vessels increase in most people over the years," according to Wolf Schaebitz, another German professor of neurology. The process can be delayed by a healthy lifestyle, including exercise and a low-fat diet. "With people without other risk factors, this sort of prevention is usually adequate," he says. But there are other factors putting certain patients at greater risk, including metabolic malfunction, high blood pressure, diabetes, being overweight, smoking and genetic predisposition. Things get serious when several of these factors are combined. Diabetics who smoke put themselves at more than twice the risk. Medication and a change in lifestyle can help to control arteriosclerosis if it is discovered in the early stages. "Medications to reduce blood pressure, lower cholesterol levels and where necessary thin the blood are used to smooth the artery walls, facilitating proper blood flow and preventing the release of deposits," Grond says. Limited calcification of the carotid artery is not always serious. Dangers arise following an initial stroke, even if it lasts only a couple of minutes. Then an operation becomes necessary to insert a stent to support the blood vessel and keep it open. Once symptoms show, calcification has reached an advanced stage and an operation should take place as soon as possible, certainly within weeks. Medication to alleviate calcification is then also essential, according to Ingo Flessenkaemper, a surgeon specialising in this kind of operation. "Symptomatic cases where the patient shows risk factors and already has problems are extremely dangerous. The restricted blood flow is not so much the problem here as the release of the deposits," he says. In the case of asymptomatic strokes, "then it should be considered whether the risk of renewed strokes can be contained by means of medication," Flessenkaemper says, adding that when narrowing reaches towards 80 per cent, an operation is recommended. A decision has to be taken between inserting a stent and removing the constriction. Most surgeons recommend removal. According to Flessenkaemper, deposits seldom recur at the site of the operation, but this is no reason to sound the all-clear. "Constriction of the carotid artery is often merely the tip of the iceberg," Grond says, pointing to an increased risk of heart attack. "One shouldn't think that everything is alright once the deposit on the carotid artery has been removed," he says. The best therapy for prevention and for post-operative care is a healthier lifestyle.
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