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Dr. Andrew Rynne

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How does carotid artery disease cause a stroke?

Answered by
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Dr. Neeraj Kumar

Neurologist

Practicing since :2006

Answered : 2264 Questions

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Posted on Tue, 12 Jun 2018 in Headache and Migraines
Question: I have a focal severe stenosis of the A1 segment of the right anterior cerebral artery. I have had repeated strokes and TIAs causing left hemiparesis, including four requiring hospitalization in the last three months, successfully treated with tPA or heparin. I have a persistently weak left hip which causes a Trendelenburg gait and right back and shoulder weakness and pain. Would it be possible and advisable to open the right A1 stenosis to 50% with angioplasty to stop the recurrent strokes and prevent further debilitation or death?
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Answered by Dr. Neeraj Kumar 1 hour later
Brief Answer:
Get evaluated as advised

Detailed Answer:
Hello,
I have gone through your question and understand your concern.
A1 segment ACA block usually is not symptomatic if there ia connection between both ACA with anterior communicating artery.
The recurrent stroke seems to be due to cardioembolic cause or large vessel atherosclerosis.
Stenting or angioplasty of A1 segment is highly demanding surgery and clear benefit is doubtful.
Treating actual cause of recurrent stroke is advisable.
Full cardiac evaluation and carotid evaluation is required.
Hope you found the answer helpful.
Do get back to me for further information.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Neeraj Kumar 28 minutes later
Dr. XXXXXXX

Thank you for your answer. I am relieved that the A1 segment is asymptomatic, so I will ignore it and concentrate on the other factors. I have hypercoagulation and am being treated with Coumadin to stop blood clots. i have a cardiologist who had me on a 10-day heart monitor and is going to do a stress test. So I think I am getting the required help according to your advice.

XXXX
doctor
Answered by Dr. Neeraj Kumar 3 hours later
Brief Answer:
Continue same treatment and get evaluated as planned

Detailed Answer:
Hello,
Yes, controlling all possible risk factors is the best strategy to avoid recurrent stroke.
Surgery is not going to help much, though imaging is required with angiography for further analysis.
Wishing you good health and early recovery.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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