HEALTH & MEDICINE :: AUGUST/SEPTEMBER 2007
Carotid Ultrasound & Stroke Prevention
Stroke is the third leading cause of death in the United States and a major cause of adult disability. Stroke is caused by an interruption of blood flow to the brain (ischemic stroke) or by ruptured blood vessels (hemorrhagic stroke). The vast majority (over 80%) of all strokes are ischemic. Half of these ischemic strokes are caused by stenoses or blockages of the carotid arteries.
We can now easily screen for these stenoses with ultrasound of the carotid arteries. The carotid arteries are the vessels that provide blood flow to the brain. Ultrasound waves are used to make an image of the arteries and measure the velocity of the blood flowing through the vessel. Based on the characteristics of the plaque formation and the velocity of blood flowing across the area, we can determine the degree of stenosis present. Typically the stenoses are graded as mild (less than 50%), moderate (50-69%, or 80% in some labs), or severe (greater than 70%). A mild or moderate stenosis requires aggressive medical treatment to decrease progression of disease and serial follow up with ultrasound imaging. Severe stenosis requires more immediate evaluation and may require surgery to remove the plaque (carotid endarterectomy). Stenting of the carotid arteries is an option for those who are not good surgical candidates and may become more widespread in the future.
How do you know if carotid artery screening is indicated? Several risk factors for stroke have been identified. Some are non-modifiable, such as increasing age, male sex and race; African Americans have increased risk. Several other factors are modifiable. These risk factors include other cardiac disease (particularly coronary artery disease, congestive heart failure and atrial fibrillation), hypertension, diabetes mellitus, hyperlipidemia, smoking and sedentary lifestyle.
Symptoms of stroke include the following:
- 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 or experiencing dizziness, loss of balance, or coordination
- Sudden headache with no known cause
It is important to note that these symptoms represent a partial list of warning signs and if you have any other unexplained symptoms please consult your physician. If you are asymptomatic but concerned about the possibility of stroke and wish to know if carotid artery screening is appropriate, your physician can provide guidance.
In summary, stroke is a leading cause of death and disability in the United States and carotid ultrasound screening is an important method to help evaluate your risks. It is a safe, simple and painless method for evaluating the blood flow to the brain. If you have any questions regarding this procedure, please feel free to ask any one of our physicians or staff.
Cardiology Physicians, P.A.
One Centurian Drive, Suite 200
Newark, DE 19713
302.366.8600
1401 Foulk Road
Foulkstone Plaza
Wilmington, DE
302.478.5055
www.cardiocppa.com
Meet the Physicians of Cardiology Physicians P.A.
Alan Micklin, M.D., F.A.C.C.
Dr. Alan Micklin joined Cardiology Physicians, P.A. in July of 2006. He began his studies as an undergraduate biology major at the University of Delaware and graduated in 1986. He then went on to attend the Hahnemann University School of Medicine from 1986 to 1990. Upon his graduation in 1990, he started his residency in Internal Medicine at Hahnemann University. He began his fellowship in cardiovascular disease at Hahnemann in 1993 and was the chief cardiology fellow from 1994-1995. Dr. Micklin is certified in internal medicine and cardiovascular disease, as well as interventional cardiology. He has also been certified to perform nuclear cardiology procedures since 1996 and is certified to read vascular carotid ultrasound studies.
Dr. Micklin specializes in both nuclear and interventional cardiology and had been practicing since 1996 in Charlotte, North Carolina before joining Cardiology Physicians. At the University of Delaware he was a member of the Phi Beta Kappa Honor Society and at Hahnemann University he was a member of Alpha Omega Alpha. He also received a commendation for Superior Performance during his residency at Hahnemann. Some of his clinical responsibilities include nuclear stress testing and echocardiography, including transthoracic, transesophageal, and stress echocardiography. As an interventional cardiologist, Dr. Micklin also performs diagnostic cardiac catheterization including intravascular ultrasound as well as stent placement and angioplasty. He has a strong commitment to inpatient and outpatient clinical patient care.
