Atherothrombotic stroke is one of the most common types of ischemic stroke. It occurs when an artery that supplies blood to the brain becomes narrowed or blocked due to the progressive accumulation of atherosclerotic plaques, reducing or preventing blood flow to a specific region of the brain.
This type of stroke typically develops as a result of arterial disease that has progressed over many years without causing noticeable symptoms. Therefore, understanding its risk factors and learning to recognize its clinical manifestations are essential for preventing complications and ensuring prompt intervention.
What is an atherothrombotic stroke?
An atherothrombotic stroke is an ischemic stroke caused by the formation of a thrombus on an atherosclerotic plaque located in an artery that supplies blood to the brain or in a large artery, such as the carotid artery.
Atherosclerotic plaques are composed of cholesterol, fats, inflammatory cells, and fibrous tissue. Over time, they can grow and significantly narrow the lumen of the blood vessel. If one of these plaques ruptures, a blood clot may form and partially or completely block blood flow.
When brain tissue is deprived of oxygen for several minutes, neurons begin to sustain damage and stroke symptoms develop.
How does it develop?
Atherosclerosis usually begins many years before the first clinical event.
The process generally progresses through the following stages:
- Accumulation of cholesterol in the arterial wall.
- Progressive formation of atherosclerotic plaques.
- Narrowing of the artery.
- Plaque rupture.
- Thrombus formation.
- Obstruction of blood flow to the brain.
In some cases, small fragments of the thrombus may break off and travel to smaller cerebral arteries, causing occlusion of distal blood vessels.
Which arteries are most commonly affected?
The most commonly affected arteries include:
- Carotid arteries.
- Vertebral arteries.
- Basilar artery.
- Major intracranial arteries.
The artery involved will determine which neurological functions are affected.
Risk factors
Most risk factors are modifiable.
The main risk factors include:
- High blood pressure.
- High cholesterol.
- Diabetes mellitus.
- Smoking.
- Obesity.
- Physical inactivity.
- A diet high in saturated fats.
- Cardiovascular disease.
- Advanced age.
- Family history of vascular disease.
Proper management of these risk factors can significantly reduce the risk of stroke.
Symptoms of atherothrombotic stroke
Symptoms occur suddenly and depend on the region of the brain affected.
The most common symptoms include:
- Weakness or paralysis on one side of the body.
- Difficulty speaking or understanding language.
- Loss of sensation in the face, arm, or leg.
- Visual disturbances.
- Dizziness accompanied by loss of balance.
- Difficulty walking.
- Sudden confusion.
In some patients, symptoms may develop progressively over several hours, particularly when the arterial obstruction gradually worsens.
Transient ischemic attacks
Before an atherothrombotic stroke, one or more transient ischemic attacks (TIAs) may occur.
These episodes cause symptoms similar to those of a stroke, but they resolve completely within 24 hours, usually within a few minutes.
A TIA is an important warning sign and requires urgent medical evaluation, as it increases the risk of a subsequent stroke in the following days or weeks.
How is it diagnosed?
Diagnosis combines clinical assessment with various imaging tests and vascular studies.
The most commonly used tests include:
- Computed tomography (CT).
- Magnetic resonance imaging (MRI).
- CT angiography (CTA).
- Magnetic resonance angiography (MRA).
- Doppler ultrasound of the carotid arteries.
- Electrocardiogram (ECG).
- Echocardiogram.
- Blood tests.
Assessment of the arteries is particularly important for identifying significant atherosclerotic plaques and evaluating the degree of arterial narrowing.
Treatment
Treatment depends on the time at which the patient arrives at the hospital, the location of the obstruction, and the patient’s clinical characteristics.
During the acute phase, the goal is to restore blood flow whenever possible and limit brain damage.
Subsequently, treatment generally focuses on preventing further events by managing risk factors and using therapies prescribed by the specialist.
In some patients with significant narrowing of the carotid artery, a procedure may be considered to improve blood flow and reduce the risk of recurrent stroke.
Prevention
Prevention is particularly important in this type of stroke, as atherosclerosis usually develops slowly over many years.
Preventive measures include:
- Controlling blood pressure.
- Maintaining healthy cholesterol levels.
- Managing diabetes.
- Quitting smoking.
- Exercising regularly.
- Maintaining a healthy weight.
- Following a diet rich in fruits, vegetables, legumes, and fish.
- Attending regular medical check-ups.
These measures not only reduce the risk of stroke but also the risk of myocardial infarction and other cardiovascular diseases.
What is the prognosis?
The prognosis depends primarily on the extent of brain damage, the promptness of treatment, and the prevention of recurrent events.
Many people are able to regain a significant degree of independence through early treatment and a rehabilitation program tailored to their individual needs. However, others may experience motor, cognitive, or language impairments that require long-term follow-up.
Conclusion
Atherothrombotic stroke is one of the most common types of ischemic stroke and results from the obstruction of an artery affected by atherosclerosis. Its onset is usually the result of a vascular process that develops over many years, making the management of risk factors essential for prevention. Early recognition of symptoms, urgent medical care, and an appropriate rehabilitation program are key to improving prognosis and reducing the risk of recurrence.
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