The relationship between TIA and stroke
Ask Dr. Keith Roach M.D
DEAR DR. ROACH: Ten years ago, I experienced a brief five-second TIA with classic symptoms. I had an MRI, which confirmed it was a stroke. But nothing was done, as it had just gone away after the five seconds. The cause was, I believe, an overdose of erectile dysfunction pills I had taken. Then about four years ago, they saw on my ultrasound that there was a 50% blockage on left carotid. Two years ago, it was 50 to 60%. Then last fall, I had a longer-duration TIA event. Again, I believe the cause was also an overdose of ED pill (only the second time I took more than the prescribed dose). There doesn’t seem to be any lasting effect, but the ultrasound now shows 70% or higher for the left carotid artery. The vascular surgeon said the blockage had progressed and he has me scheduled for a carotid surgery, not a stent, in a few weeks. He told me the operation has a 3% heart attack risk, so I’m apprehensive. I haven’t been scheduled for any preop heart check. I really feel all right and I’m thinking that these two TIAs would not have occurred if I didn’t overdose on the ED pills. So, I’m thinking that an alternative to surgery at this point might be to go on an artery- cleansing diet and hope that it can clear out the artery enough to lower my risk. I see in YouTube all the time videos about certain foods, drinks or diet regimens that clear arteries! Is this a reasonable alternative to life-threatening surgery? I just turned 80 and have been in excellent health. — J.C. ANSWER: There’s a lot for me to comment on here, but let me start with the relationship between TIA (transient ischemic attack) and stroke. Both of these are a type of damage to brain cells coming from lack of oxygen to the brain tissue. In a TIA, the cells are not permanently damaged, whereas there is cell death in a stroke. Symptoms from TIAs last for a short while, almost always less than 24 hours, and strokes are highly variable: Some can show no symptoms at all, some very mild and transient symptoms, while others may cause permanent or catastrophic damage. In your case, the blockages in the carotid artery suggest that you have had TIAs or strokes due to poor blood flow. Drugs like Viagra, especially if taken in too-large doses, can cause a transient drop in blood pressure. When combined with blockages in the arteries, it can cause such poor blood flow to the area as to cause a TIA. A stroke would be rare but possible, so please stop taking excess doses (I would be concerned about prescribing these drugs at anything other than low dose, to be frank). Unfortunately, you are still at risk even without ED drugs. Surgery for blocked carotid arteries in symptomatic people with a blockage of 70% or more is considered the standard of care. Surgery does have a risk of damage to the heart, so an evaluation of the heart should be considered, especially in people with blockages in the carotid and who are at higher risk for blockages in the heart. While I recommend a healthy diet, which can certainly help with blockages, there is no miracle food, drink or supplement that can clear out arteries. If there were, nobody would need surgery. Medical management, including statins, aspirin (or other antiplatelet drug) and blood pressure control if necessary, has a significant benefit as well. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYour-GoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
