Understanding Atherosclerosis: The Artery Problem Behind Most Strokes

Most strokes don’t happen without warning. In many cases, there is an underlying artery problem that develops silently for years before it leads to a crisis. That problem is called atherosclerosis. Understanding what it is, how it leads to stroke, and what can be done about it early can often make the difference between life and death.

What Is Atherosclerosis?

Atherosclerosis is the gradual build-up of fatty deposits, known as plaques, inside the walls of arteries. Over time, these plaques harden, narrow the artery, and reduce the flow of blood through it. In some cases, a plaque can rupture, triggering a blood clot that blocks the artery completely.

How it develops:

• Fat, cholesterol, and other substances accumulate on the inner artery wall
• The immune system responds, causing inflammation
• A fibrous cap forms over the fatty deposit, creating a plaque
• The plaque grows over years, progressively narrowing the artery
• If the plaque ruptures, a clot can form rapidly causing sudden blockage

It is worth noting that atherosclerosis is not a disease of old age alone. Fatty streaks, which is the earliest stage of this condition, have been found in people in their twenties. By the time symptoms appear, the disease is usually well advanced.

Why does it matter for stroke?
The brain depends on a continuous, uninterrupted blood supply. It has no energy reserves of its own. When blood flow is reduced or cut off even briefly, brain cells begin to die within minutes. Atherosclerosis is the leading underlying cause of ischaemic stroke, which accounts for around 85% of all strokes.

Your Atherosclerosis Risk Checklist

How many of these apply to you?

If you ticked two or more boxes, a vascular assessment is worth discussing with your doctor.

How Does Atherosclerosis Lead to a Stroke?

There are two main ways atherosclerosis triggers a stroke:

1. Gradual narrowing: As plaque accumulates, the artery becomes progressively narrower. Blood flow to the brain slows. The brain may compensate for a while, but eventually, particularly during periods of low blood pressure or increased demand, parts of the brain are starved of oxygen. This often produces TIAs (transient ischaemic attacks, or "mini strokes") before a full stroke occurs.

2. Plaque rupture: If the fibrous cap over a plaque cracks or ruptures, the contents are exposed to the bloodstream. The body's clotting response kicks in immediately, forming a clot on top of the ruptured plaque. That clot can either block the artery at the site of rupture, or break off and travel upstream to block a smaller artery in the brain. This is called embolism.

Which Arteries Are Most Involved in Stroke?

The carotid arteries, which run up each side of the neck are the most clinically significant in terms of stroke prevention. Narrowing here (carotid stenosis) is detectable, treatable, and a well-established cause of stroke. This is why carotid screening plays such an important role in high-risk individuals.

Who Is Most at Risk?

Atherosclerosis is driven by a combination of lifestyle factors, medical conditions, and genetics. Risk factors fall into two categories:

The more modifiable risk factors you have, the greater the cumulative damage to your arteries over time. Importantly, most of these factors are addressable, which is why atherosclerosis is largely a preventable disease.

Warning Signs You Shouldn't Ignore

Atherosclerosis itself causes no symptoms until the artery is significantly narrowed or a plaque ruptures. When symptoms do appear, they are often the brain's way of signalling that blood flow is compromised.

Any of these symptoms, even if they pass quickly, must be treated as a medical emergency. A TIA is often the last warning before a major stroke. Around 10–15% of people who have a TIA will have a full stroke within 90 days, with the highest risk in the first 48 hours.

Recognising Stroke: FAST

Other symptoms to watch for: sudden severe headache, sudden vision loss, sudden loss of balance.

How Is Atherosclerosis in the Brain Arteries Detected?

Screening is particularly recommended for people with multiple risk factors, those who have experienced a TIA, and anyone with a family history of early stroke or vascular disease.

Can Atherosclerosis Be Treated Before a Stroke Happens?

Yes. Detecting Atherosclerosis before symptoms appear creates a critical window to reduce the risk of a stroke. When treated at this stage, interventions can slow disease progression, improve blood flow, and significantly lower the chances of a future stroke. Acting early is far more effective than trying to treat the condition after damage has already occurred.

Advanced Treatments to Restore Blood Flow

When narrowing is severe intervention may be needed to directly address the blockage and prevent stroke.

Both carotid endarterectomy and carotid stenting are proven to significantly reduce stroke risk in patients with significant carotid stenosis. The choice between them depends on the degree of narrowing, the location of the plaque, the patient's general health, and individual anatomy.

Prevention: What You Can Do Starting Today

Atherosclerosis can be slowed, stabilised, and in some cases partially reversed with consistent lifestyle change and appropriate medical treatment.

• Stop smoking — the single highest-impact change you can make
• Control your blood pressure — target below 130/80 in most cases
• Manage cholesterol — diet, exercise, and statins if indicated
• Control blood sugar — uncontrolled diabetes accelerates artery damage dramatically
• Exercise regularly — at least 150 minutes of moderate activity per week
• Eat a Mediterranean-style diet — proven to reduce cardiovascular and stroke risk
• Maintain a healthy weight — reduces blood pressure, cholesterol, and inflammation
• Attend regular screening — especially if you have multiple risk factors

When to See a Vascular Specialist

Consider a specialist evaluation if you:

• Have had a TIA or any brief neurological symptom
• Have been told you have carotid plaque or stenosis on any scan
• Have high blood pressure that is difficult to control
• Have multiple cardiovascular risk factors and no recent vascular screening
• Have a strong family history of stroke or early heart disease
• Are over 60 with diabetes, smoking history, or raised cholesterol

Early consultation gives you the most options. A vascular specialist can assess the health of your arteries, quantify your risk, and recommend the most appropriate next step. whether that is closer monitoring, medication adjustment, or a procedure to restore blood flow.

Why Choose RIVEA for Stroke & Carotid Disease Care

• International Expertise in Vascular Surgery – Led by Dr. Karthik Mikkineni, an internationally recognized vascular and endovascular surgeon with extensive experience in carotid artery disease and stroke prevention.
• Advanced Carotid Disease Treatment – Expertise in diagnosing and treating carotid artery narrowing, a major cause of stroke, using both open surgery and minimally invasive endovascular techniques.
• Experienced Vascular Specialists – Supported by Dr. Syed Mohammed Ali Ahmed, a vascular surgeon with significant experience managing complex carotid and vascular conditions.
• Comprehensive Stroke Prevention – Focused care aimed at early detection, accurate diagnosis, and timely treatment of vascular conditions that can lead to stroke.
• Modern, Minimally Invasive Treatments – Access to advanced endovascular procedures and image-guided interventions designed to restore blood flow with smaller incisions and faster recovery.
• Dedicated Vascular Institute – A specialized center focused exclusively on vascular and endovascular care, enabling coordinated management of carotid disease and stroke risk.