World Stroke Day 2025: Carotid Artery Disease and Stroke Prevention

Some strokes can be prevented by treating disease in the carotid arteries, the major arteries in the neck that supply the brain. For World Stroke Day, my video explains this part of vascular surgery and an equally important message: recognising stroke symptoms must lead to immediate action.

If someone develops sudden facial weakness, arm weakness or difficulty speaking, call 995 in Singapore. Do not wait for a clinic appointment. The same applies if the symptoms improve or disappear.

How can carotid artery disease cause a stroke?

Fatty material, known as plaque, can build up inside a carotid artery and narrow it. A clot or debris associated with that plaque can travel towards the brain and interrupt its blood supply, causing an ischaemic stroke.

Carotid disease is one possible cause of stroke. Clots can also arise from the heart, including in people with atrial fibrillation, or develop within arteries in the brain. Other strokes are caused by bleeding. Identifying the cause matters because prevention and treatment need to address the particular problem.

Can a vascular operation prevent every stroke?

No. Carotid procedures reduce stroke risk in selected people whose artery disease is suitable for treatment. They cannot prevent strokes from every cause and are not appropriate for everyone with a narrowing.

The decision depends on the degree of narrowing, whether it has caused a recent stroke or transient ischaemic attack, the anatomy of the arteries, the person’s health and the risks of the proposed procedure. A narrowing found without symptoms requires a different discussion from one associated with a recent neurological event.

What are carotid endarterectomy and carotid stenting?

Carotid endarterectomy is an operation to remove plaque from within the affected artery. Carotid artery stenting treats the narrowing with a small mesh tube placed through a catheter. The choice between procedures depends on an individual assessment; a less invasive approach is not automatically the right option for every person.

Both procedures have potential complications, including stroke. The expected benefit must outweigh those risks. If an intervention is recommended, the treating team should explain why it is appropriate, how soon it is needed and what recovery and follow-up involve.

Does prevention still involve medicines and daily habits?

Yes. Care for carotid artery disease also includes managing vascular risk. Depending on the diagnosis, this may involve prescribed antiplatelet and cholesterol-lowering medicines, blood pressure and diabetes management, and support to stop smoking.

Physical activity, nutrition and taking prescribed treatment consistently remain relevant whether or not an operation is advised. Do not start, stop or change medication because of a general article; your own plan should reflect your medical history.

What does FAST mean?

• Face: a sudden droop or weakness on one side of the face.

• Arms: sudden weakness or difficulty keeping one arm raised.

• Speech: new slurring, difficulty speaking or trouble understanding speech.

• Time: call 995 immediately if any of these signs appears.

All three signs do not need to be present. Sudden loss of vision, loss of balance or other new neurological symptoms can also be important. Note when symptoms started, or when the person was last known to be well, and tell the emergency team.

What if the symptoms have already gone away?

A transient ischaemic attack, or TIA, can produce stroke-like symptoms that resolve. It is still an emergency warning, not a reason to wait and see. Urgent assessment is needed to establish the cause and reduce the risk of a subsequent stroke.

If carotid disease is identified, the specialist team may arrange ultrasound or other imaging and discuss medical treatment and whether a procedure is indicated. The role of vascular surgery is part of that wider assessment.

For planned assessment of known carotid artery disease, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. For new stroke or TIA symptoms, call 995 immediately.