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Drs. Iyengar and Zacharias on Reducing Your Stroke Risk

Drs. Iyengar and Zacharias on Reducing Your Stroke Risk

Strokes strike nearly 800,000 Americans each year, killing about 135,000 and forever changing the lives of those who survive.

In honor of National Stroke Awareness Month, BCH hosted a free online health lecture. Interventional cardiologist and BCH's structural heart program director Srini Iyengar, MD, and neurologist Alan Zacharias, MD, co-presented the lecture and described the causes of stroke, warning signs and ways to lower your risk.

What is a Stroke?
“A stroke occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain,” said Dr. Zacharias, who started off the lecture. “This deprives the brain of oxygen and nutrients. Brain cells begin to die within minutes.”

He then went on to explain the two broad categories of stroke: ischemic (brain clot) and hemorrhagic (brain bleed).

“An ischemic stroke is the most common type, responsible for more than 85% of strokes. It occurs when a blockage of an artery cuts off blood flow to a part of the brain,” Dr. Zacharias said.

Ischemic strokes can be caused by:

  • Embolism - a blood clot that travels from the heart or blood vessel up to the brain
  • Thrombosis - a blood clot that develops in the blood vessels inside the brain

Dr. Zacharias said that these clots may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow.

“The other type of stroke, hemorrhagic, occurs when a blood vessel in your brain leaks or ruptures. Blood spills into or around the brain and creates swelling and pressure. While hemorrhagic stroke is less common, it's more deadly, ” stated Dr. Zacharias.

Warning Signs of a Stroke
Dr. Zacharias said, “There are a number of symptoms for stroke. Any sudden changes can be a stroke.” The most common signs are:

  • Sudden numbness or weakness of face, arm or leg, especially on one side of the body.

  • Sudden confusion, trouble speaking or understanding.

  • Sudden trouble seeing in one or both eyes.

  • Sudden trouble walking, dizziness, loss of balance or coordination.

  • Sudden severe headache with no known cause.

One way to help remember the symptoms of stroke and what to do is to learn the acronym B.E.F.A.S.T.:
B - Balance: Watch for sudden loss of balance
E - Eyes: Check for vision loss
F - Face: Look for an uneven smile
A - Arm: Check if one arm is weak
S - Speech: Listen for slurred speech
T - Time: Call 9-1-1 right away

Also, check the time so you’ll know when the first symptoms appeared.

“People sometimes experience a transient ischemic attack, or TIA, which symptoms resemble those found in a stroke but usually last a few minutes. Even if all symptoms quickly resolve, it's still very important that you call 9-1-1 and immediately be evaluated by a qualified physician. A TIA is a warning sign of a possible future stroke and is treated as a neurological emergency,” said Dr. Zacharias.

Time is of the Essence for Treatment
"Never wait to see if symptoms will go away!" Dr. Zacharias warned. “You need to act quickly to save yourself or a loved one from potential disability or death.”

According to Dr. Zacharias, if you suffer an ischemic stroke, doctors work to restore blood flow to your brain with:

  • An injection of blood-thinning medication called tissue plasminogen activator (tPA), the gold standard treatment for ischemic stroke.
  • Emergency endovascular procedures, which are procedures performed directly inside the blocked blood vessel for those ineligible for tPA treatment. Doctors may insert a catheter through a groin artery and thread it to your brain to deliver tPA directly into the area where the stroke is occurring. Or, doctors may use a catheter to maneuver a device into the blocked blood vessel and pull out the clot.

Other treatments may include surgical procedures that open up a narrowed artery running along the side of your neck to your brain.

For hemorrhagic stroke, treatment involves surgical procedures: open surgery that uses a metal clip to close the bleeding area or endovascular coiling, a minimally invasive treatment that uses a catheter to fill the bleeding area with a platinum-wire coil.

Identifying Your Risk Factors
Dr. Zacharias explained that there are some risk factors for stroke you can't control, but it’s important for you to know them.

He said that genetics contributes to about 50 percent of your stroke risk. “Stroke tends to run in some families. Members of a family might have a genetic tendency for stroke risk factors such as an inherited predisposition for diabetes or high blood pressure.”

Dr. Zacharias noted that some of the most important treatable and modifiable risk factors for stroke are:

  • Hypertension (the No. 1 risk factor)
  • Diabetes
  • Cigarette smoking
  • Elevated cholesterol
  • Physical inactivity
  • Atrial fibrillation, a type of irregular heartbeat

He recommended talking to your health care provider about how to lower your risk for stroke if you have one of the above risk factors.

Reducing Your Risk From Atrial Fibrillation

Atrial fibrillation (AFib) can significantly decrease the heart’s pumping capacity, which increases the risk of clots forming—particularly in the left atrial appendage (LAA), a small sac in the left atrium (the top left heart chamber).

“If a clot escapes from the heart and travels to another part of the body, it may limit blood supply to the brain and cause a stroke,” said Dr. Iyengar. “According to the National Stroke Association, AFib raises a person's risk for stroke by 500 percent.”

Blood-thinning medications, such as warfarin (Coumadin®), are the most common treatment for preventing AFib-related stroke. These clot-preventing medications can greatly reduce stroke risk if taken properly and no side effects are seen.

“Yet, there are barriers to taking a blood thinner, including dangerous interactions with other medications, dietary restrictions, high prescription costs and concerns about bruising or excessive bleeding from an injury," Dr. Iyengar stated. Additionally, their effectiveness varies because of interactions with certain foods and medications, thus requiring frequent blood tests and dose adjustments. As a result, about 1 in 4 patients discontinue blood thinners after two years.

Dr. Iyengar said because of these concerns, the Watchman procedure could be an alternative to taking blood-thinning medications for some AFib patients.

Watchman is a one-time procedure performed under general anesthesia in a catheterization laboratory setting for people with non-valvular AFib (not caused by a heart valve problem) who need an alternative to blood thinners. The procedure usually lasts about an hour and the patient is typically in the hospital for 24 hours following the procedure. Learn more about Watchman here.

BCH is a Primary Stroke Center
BCH has been awarded Advanced Certification as a Primary Stroke Center by The Joint Commission and the American Heart Association/American Stroke Association. The Joint Commission’s Primary Stroke Center certification recognizes centers that make exceptional efforts to foster better outcomes for stroke care. Achievement of certification signifies that the services provided at BCH have the critical elements to achieve long-term success in improving outcomes. To learn more about our primary stroke center, click here.

View PowerPoint slides from the lecture on “Reducing Your Stroke Risk.” If you'd like to schedule an appointment with our lecture presenters, you can reach Srini Iyengar, MD, at 303-442-2395, or Alan Zacharias, MD, at  303-415-8800.

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