How Artery Widening (Not Just Narrowing) Can Also Cause Strokes

We’ve written about stroke before; most centrally, our “how to” article, Reduce Your Stroke Risk ← so definitely do check this one out and do those things!

All that remains valid, but a new risk factor has been identified, and, paradoxically, it’s the widening of arteries:

Too wide!

Researchers (Dr. Joanna Wardlaw et al.) have done a study whose results challenge the long-standing idea that lacunar ischemic stroke (a common small vessel stroke) is mainly caused by fatty plaque narrowing in larger arteries; instead, Dr. Wardlaw and her team found that widened, enlarged brain arteries (arterial dolichoectasia) were much more strongly linked to lacunar stroke and cerebral small vessel disease (with 4x greater risk thereof).

As to how this problem arises when logically a wider blood vessel should mean better blood flow, the paper (that we’ll link shortly) discusses how “nonatheromatous intrinsic microvascular pathology” is to blame, which translating from sciences, means the structural disorganization of small brain arterioles, rather than the cholesterol plaque buildup in larger vessels.

In other words, imagine if your house were built quite a bit larger but with only the same building materials; you see how it’d have problems? Same deal for your blood vessels.

This means that antiplatelet drugs such as aspirin mainly target clotting and atherosclerotic plaque-related events, but if lacunar stroke is primarily driven by intrinsic small vessel structural damage rather than plaque blockage, then antiplatelet approaches are not likely to be a lot of help in this case!

Important note: this does not mean that arterial narrowing (let alone blockage) is fine. It’s not. It just causes different strokes for different folks, so to speak. And, by consequence, this also doesn’t mean cholesterol, plaque, or antiplatelet therapy are unimportant for all stroke types (indeed, atherosclerosis remains a major cause of many other strokes) but simply that lacunar stroke will require other approaches:

❝This study provides strong evidence that lacunar stroke is not caused by fatty blockage of larger arteries, but by disease of the small vessels within the brain itself.

Recognizing this distinction is crucial, because it explains why conventional treatments like antiplatelet drugs are not as effective for this type of stroke and highlights the urgent need to develop new therapies that target the underlying microvascular damage❞

~ Dr. Joanna Wardlaw

So, research in this regard will now be focusing on protecting or restoring small vessel integrity rather than just on (the also worthy goal of) preventing clot formation; the same team’s LACI-3 trial is already testing whether drugs such as cilostazol and isosorbide mononitrate will better target these mechanisms.

You can read the paper in full, here: Implications of Cranial Arterial Stenosis and Dolichoectasia for Cerebral Small-Vessel Disease Etiopathogenesis: Findings From a Prospective Mild Stroke Cohort

But what if you do have a stroke?

All is not necessarily lost; there are options! For example: What To Do If Having A Stroke Alone? ← with the caveat that, if you have a stroke, there’s a good chance you’ll forget all this. However, this is good to know anyway, in case someone else is having a stroke (and if you don’t live alone, it can be good for whoever is with you to know this too).

There are also such resources as: Reverse Stroke Damage (Within A 6-Hour Window) ← there is a drug that does this now, but time is of the essence

Want to learn more?

Everyone even vaguely health-conscious knows that prevention is better than cure, but many still don’t think about a lot of things until they’re too late, and stroke definitely falls all-too-often into that category:

❝Each year in the US, over half a million people have a first stroke; however, up to 80% of strokes may be preventable.❞

~ American Stroke Association

Source: New guideline: Preventing a first stroke may be possible with screening, lifestyle changes

To be ahead of that curve, check out:

Don’t Get Caught Out By These “Nontraditional” Stroke Risk Factors

And, for that matter,

6 Signs Of Stroke (One Month In Advance)

Take care!