Carotid Artery Occlusion After a Stroke: Key Concerns

What to do about carotid artery occlusion?

My mother recently suffered a stroke, presenting with facial drooping, eye misalignment, drooling, and weakness in her legs.
After being sent to the hospital for treatment, she was diagnosed with a cerebrovascular accident.
The physician performed an MRI and angiography.
I would like to ask the doctor the following questions:
1.
During the MRI examination, my mother experienced unbearable numbness throughout her body.
Why did this happen? That night, she had severe body aches that prevented her from sleeping (she occasionally experiences body aches, which come and go).
2.
The MRI and angiography confirmed that my mother has complete occlusion of the right carotid artery, and the left carotid artery is also blocked, with multiple areas of the brain affected.
Given that my mother is in her seventies, we are hesitant to proceed with surgery and are only considering medication.
Since the carotid artery is completely occluded, is there a possibility that she could have a major stroke at any time in the future?
3.
She has now been discharged.
If she experiences another minor stroke, should she be taken to the hospital again?
4.
In fact, several years ago, a neurologist diagnosed my mother with significant narrowing of the carotid artery but did not prescribe any medication.
Why was that? Did they believe that medication would be ineffective?

Da Sha Gua, 40~49 year old female. Ask Date: 2017/11/14

Dr. Jiang Junyi reply Neurology

Based on your description of the symptoms of generalized muscle pain, it is possible that during the magnetic resonance imaging (MRI) examination, patients are typically instructed to remain still to achieve better imaging, which can lead to muscle tension and discomfort.
Your mother has carotid artery lesions and has experienced a stroke in the past, which significantly increases her risk of another stroke.
It is essential to manage risk factors such as blood pressure and lipid levels.
If she experiences sudden neurological deficits, such as limb weakness or speech difficulties, a recurrent stroke should be the primary concern, as she is considered a high-risk patient.
The physician will likely prescribe anticoagulant medications for stroke prevention.
Therefore, if acute neurological symptoms occur, the possibility of a hemorrhagic stroke should also be considered.
It is advisable for you and your mother to continue follow-up appointments in the neurology clinic.
Wishing you both good health, peace, and happiness.

Reply Date: 2017/11/14

More Info

Understanding carotid artery occlusion after a stroke is crucial, especially in the context of your mother's recent medical history. Here are the key concerns and explanations regarding her condition.

1. MRI Discomfort: The discomfort your mother experienced during the MRI scan, including the sensation of her body being "numb" and subsequent muscle soreness, can be attributed to several factors. MRI machines use strong magnetic fields and radio waves to create images, which can sometimes cause anxiety or discomfort, especially in patients who may be claustrophobic or sensitive to the noise produced by the machine. Additionally, lying still for an extended period can lead to muscle stiffness or soreness, particularly in older adults. If your mother has a history of muscle pain, this could have been exacerbated by the MRI process. It’s important to communicate these experiences to her healthcare provider, as they may consider using sedation or other methods to improve comfort during future imaging.

2. Carotid Artery Occlusion and Stroke Risk: The findings from the MRI angiography indicating complete occlusion of the right carotid artery and significant narrowing of the left carotid artery are concerning. Complete occlusion means that blood flow through that artery has been entirely blocked, which can significantly increase the risk of future strokes. The brain relies on a consistent blood supply, and when arteries are blocked, the risk of ischemic events (where parts of the brain do not receive enough blood) increases. Given your mother's age and the severity of her condition, it is understandable that surgical interventions may be deemed too risky. However, medical management, including antiplatelet therapy (like aspirin or clopidogrel) and statins, is crucial to reduce the risk of further strokes.

3. Signs of a Recurrent Stroke: If your mother experiences any new symptoms, such as sudden weakness, difficulty speaking, facial drooping, or changes in vision, it is imperative to seek immediate medical attention. These could be signs of a transient ischemic attack (TIA) or a full-blown stroke. Even if she has been discharged, the risk of recurrent strokes remains high, particularly with the current state of her carotid arteries. Monitoring her condition closely and having a plan in place for emergencies is essential.

4. Previous Diagnosis and Treatment Decisions: The earlier diagnosis of carotid artery narrowing without subsequent treatment may seem perplexing. In some cases, physicians may determine that the degree of narrowing does not warrant immediate intervention, especially if the patient is asymptomatic. The decision to treat or not can depend on various factors, including the patient's overall health, the presence of other risk factors (like hypertension, diabetes, or hyperlipidemia), and the potential risks associated with surgical procedures. It’s also possible that the physician believed that lifestyle modifications and monitoring would be sufficient at that time. However, given the recent developments, it may be worth discussing with her current healthcare provider why the previous diagnosis did not lead to treatment and whether any changes in management are warranted now.

In summary, your mother’s situation is serious, and ongoing management is essential to minimize the risk of further strokes. Regular follow-ups with her healthcare team, adherence to prescribed medications, and lifestyle modifications (such as diet and exercise, as tolerated) are critical components of her care plan. It’s also important to maintain open communication with her doctors about any new symptoms or concerns that arise.

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