Carotid Artery Disease and Stroke Prevention in Singapore

Carotid artery disease is narrowing of an artery in the neck that supplies blood to the brain. It is usually caused by a build-up of plaque, called atherosclerosis. A clot or material from this plaque can travel to the brain or eye and interrupt blood flow. Treatment aims to reduce the risk of stroke, using medicines and lifestyle measures, with a procedure for selected patients. Not every carotid narrowing needs an operation.

Stroke or TIA symptoms: seek emergency help

Sudden face drooping, weakness or numbness on one side, difficulty speaking or understanding speech, or loss of vision needs emergency assessment. A sudden problem with balance or coordination can also be a stroke warning sign. In Singapore, call 995 immediately. Do not drive yourself or wait for a clinic reply.

The same urgent action applies if the symptoms disappear. A transient ischaemic attack (TIA) can cause brief stroke-like symptoms and warns of a possible further event. You cannot safely distinguish a TIA from a stroke at home. Note when symptoms started, or when the person was last known to be well, and tell the emergency team.

For a planned review of carotid narrowing, contact the clinic with information about existing scan reports and treatment advice. See how to prepare for your consultation. New stroke or TIA symptoms require emergency assessment, even if they improve.

Who develops carotid artery disease?

Smoking, high blood pressure, high cholesterol, diabetes and increasing age contribute to atherosclerosis. Carotid disease may be found during an assessment even when there have been no warning symptoms. It can occur alongside heart disease or peripheral arterial disease in the legs.

Not all strokes arise from the carotid arteries. Heart rhythm problems, disease of smaller brain vessels and bleeding are among other causes. The assessment must establish whether a carotid narrowing is relevant to the symptoms, rather than assume that any plaque found on a scan caused the event.

How is carotid narrowing assessed?

The history of any weakness, speech disturbance or visual loss matters, including which side was affected and when it occurred. I review this alongside the examination, medicines and available brain and artery imaging.

• Carotid duplex ultrasound examines plaque and blood flow in the neck arteries.

• CT or MR angiography can provide additional detail or help plan treatment.

• Brain imaging and stroke assessment help establish what happened and whether another cause needs attention.

Further tests depend on the clinical question; everyone does not need every scan. A reported percentage of narrowing must be interpreted alongside symptoms, the measurement method and the rest of the findings. My introduction to duplex ultrasound explains what this type of examination can show. Our carotid duplex and vascular-lab services explain the available assessment and why routine screening is not advised for everyone.

What are the treatment options?

Medical treatment and risk-factor control

Medicines and lifestyle measures remain important whether or not a procedure is recommended. Care commonly includes cholesterol-lowering treatment, blood-pressure and diabetes management, smoking cessation and antiplatelet medicine when appropriate. The choice of medicines depends on the diagnosis, other conditions and bleeding risk; do not alter them on your own.

Healthy activity and eating habits support long-term vascular health. After a stroke, activity and rehabilitation should follow the treating team's advice. Medical treatment continues after carotid surgery or stenting because a procedure does not remove the underlying tendency to develop atherosclerosis.

Carotid endarterectomy

Carotid endarterectomy is an operation through an incision in the neck to remove plaque from inside the artery. It can reduce future stroke risk in appropriately selected patients, particularly when a significant narrowing has recently caused symptoms. The expected benefit must be weighed against the risks of the operation and anaesthesia.

Carotid artery stenting

Stenting uses a catheter-based approach to place a small supporting mesh tube within the artery. It is an option for selected patients. Suitability depends on the artery's anatomy, age, other illnesses and the risks associated with each approach. A less invasive approach is not automatically the safer or more effective choice for an individual.

Choosing treatment with or without symptoms

A recent carotid-related TIA or stroke changes the urgency and potential benefit of treatment. Significant narrowing without recent symptoms requires a different discussion about medical treatment, monitoring and whether adding a procedure offers sufficient benefit. Current evidence, the likely course of the disease, procedural risks and your preferences all matter. A single percentage on a scan cannot make that decision.

Common questions about carotid disease

Does a normal examination rule it out?

No. Carotid narrowing may cause no obvious physical signs. The need for imaging depends on symptoms, previous findings and an individual assessment.

Can treatment guarantee that I will not have a stroke?

No. Treatment aims to lower risk, but neither medicines nor a procedure removes every possible cause of stroke. Follow-up and cardiovascular risk management remain important.

What happens after surgery or stenting?

Recovery and follow-up depend on the procedure, general health and whether there has been a recent stroke. Your team should explain medicines, wound care where relevant, activity and any follow-up imaging. New stroke symptoms always require emergency help, including after treatment.

Arrange a planned carotid review in Singapore

For non-emergency review of a scan, known carotid disease or treatment options after hospital assessment, contact Andrew Choong Vascular Surgery at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Bring relevant scan reports, discharge information and your medication list. Read my article on carotid artery disease and stroke prevention, or learn more about Dr Andrew Choong.

Carotid disease and stroke prevention video

Watch Dr Andrew Choong’s introduction to carotid artery disease and stroke prevention, including the FAST warning signs. The carotid section of the video library connects the video with the relevant condition and treatment guides.

For the wider connection between heart, brain and leg circulation, watch Dr Choong’s World Heart Day video or read the accompanying article. New stroke or TIA symptoms still require emergency assessment.