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Carotid Artery Stenting (CAS)

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Post questions and comments about Carotid Artery Stenting in this topic. Carotid stenting was first approved in the U.S. in 2004. If you or a family member has had the procedure, our readers would be greatly helped by your comments, both positive and negative. (Postings are listed newest to oldest.)

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Current Postings on This Page (103):

• Pickett1 - This is a topic about Carotid Artery Stenting, which is an interventional alternative to surgery (endarterectomy). That being said, we would definitely recommend contacting the surgeon who performed the procedure and let him/her know your symptoms. When you went to the ER, did they do non-invasive imaging tests (CT, MR, ultrasound)?
Angioplasty.Org Staff, Angioplasty.Org, June 1, 2022

• I had a Carotid Endarterectomy (left side) on 4/22/22. Today I'm six weeks out. Every few days I get tightness in my lower skull/rear neck and pressure in my ears/forehead. When this happen I begin to feel horrible (low energy/tired). I'm a 59 year old male triathlete. Been back to ER multiple times and tested for EVERYTHING. Anyone experience this? Am I still feeling affects of surgery?
Pickett1, Mandeville, June 1, 2022

• I had carotid artery stent put in the left side of my neck, going in through my grion. My blood pressure and oxygen dropped.... I became bradycardic and hypotensive requiring vasoprressors. I ended up in ICU for a few days. Usually a person having this type of surgery stay in hospital one night and go home next day. I was in the hospital for 5 days. When I woke up my voice was very weak and couldnt speak hardly. My voice has been absent...struggle to whisper....this causes pain in neck area traveling out collar bone and chest, neck area to point I can't whisper. My digestive system don't work on its own, I have to take stool softener with laxative. I also break out in a clammy sweat lasting 2 to 3 min but comes over me often. I can not deal with my personal affairs because I become fatigued and sweat from trying to talk and can't talk longer due to pain, sweats and anxiety. The surgeon has never heard of this problem after a patient underwent a carotid surgery stent surgery. Has anyone ever heard of or encountered this problem. I still do not have my voice back. This problem is so bad for me that it makes me cry at times, out of frustration from pain from trying to speak
Maggie, Personal, Bible Hill, Nova Scotia, Canada, October 24, 2021

• 49 yr old male with narrowed carotid artery. Nothing remarkable found during Cath of the heart. All other tests show a 40-60% blockage of the carotid and jugulars. Won't see Cardiologist for another week. Inviting comments as to what to do. A-typical chest pain was event that started the testing. Chest pain is believed to be Bundle Branch Blockage (which occurred during the stress test). Treatment is metoprolol 12.5mg twice a day.
49 yr old male with narrowed carotid artery, Lakeland, Florida, USA, June 27, 2013

• Thank you for your response. I have seen a vascular surgeon and neurosurgeon. Because my left internal carotid artery pseudoaneurysm is in too difficult of an area they have told me they can not operate on me w/stenting. They believe they could do more damage to me than good. they have opted to watch it and give me MRA. I have no clogged arteries and all blood work came back positive. My dissection healed on its own. Have you ever heard of a pseudoaneurysm healing on its own?
jbourne, Bourne, Massachusetts, USA, May 5, 2013

• JBourne -- Wish we could help but (a) we cannot give out "medical advice" that can substitute as a consultation with a doctor; and (b) one really would need to see all your records to do so. We think seeing a vascular surgeon is a very good idea.
Angioplasty.Org Staff, Angioplasty.Org, April 11, 2013

• Hi I just went to neurologist with Horner's symptoms and pain in my neck and right leg. My PCP sent me to ER. Since they did a CT and chest xray and found I had a carotid artery dissection that healed itself and left a pseudoaneurysm (7.8m). They sent me home and said they weren't concerned about this. It concerns me because I still have Horner's and in pain. I am seeking out a vascular surgeon to see if I should do something about it. The neurologist said the pseudoaneurysm was too small to worry about. Is this true?
JBourne, Bourne, Massachusetts, USA, April 10, 2013

• You are very welcome, Mona! Happy Valentine's Day to you as well! :)Trudy
Trudy, Kansas City, Missouri, USA, February 11, 2013

• Thank You so much Trudy! ♡♥♡♥♡♥ Happy Valentine's Day to you.
Mona61, McGregor, Iowa, USA, February 11, 2013

• Hi Mona, it sounds as though you are ok whereas mine was advanced! But just have a right to see all of your medical records especially since "Obamacare" became law. YOU are the official OWNER of them and you can see them anytime and anyplace.....all you have to do is tell them you want them or you want a copy of the blood work results! Good luck to you! Trudy in Missouri
Carotid artery stenting, Kansas City, Missouri, USA, February 11, 2013

• McGregor, Iowa Post Dr office visit, Dr called to state lifeline screening would be in my area. I booked the vascular set of tests- $149.00 credit card now maxed. Received results from Lifeline Screening, stated (mild) right carotid artery. Left carotid artery (normal). Sent copy to my Dr who stated in a letter results 'normal' and not to worry. All other vascular screenings were normal. Still would like CBC results. Received the Dr office bill with total due w/o blood numbers. They took two vials-i'd like to know! Would be interested in lowering my cholesterol naturally if possible with diet & supplements. But need blood work info first. I feel like I was scared into getting tested bcuz she heard a bruit in left carotid she stated 3 yrs ago-was in my chart. Why don't I remember that office visit? I have to be my own advocate. Mona from McGregor, Iowa. Thank You.
Mona61, McGregor, Iowa, USA, February 11, 2013

• This is in response to [the woman from] McGregor [below]! Get a second opinion very soon! I had a doctor who delayed a sonogram and I had over 100 TIA's. I also wound up having 100% blocked carotid as a result which later opened on it's own. All the docs said they had NEVER seen that happen before. I currently have 4 stents inside each other as the stents began to close off and a new one was necessary. So, GET A SECOND OPINION if your doctor ignores you or says it's nothing and not to worry about it!!!
Carotid artery stenting, Missouri, USA, February 10, 2013

• Just went to the doctor today. Turned 51 Dec 22nd. Apparently I am in the early stages of perio menopause. Pap exam. Doc checked my last exam 2009, blood work done, thyroid panel and cholesterol. Cholesterol: 240- 130 Lbs. She wondered why not complete blood count done. Anyway, doc stated she saw my records from 2009 and it had stated a left side bruit on left side carotid artery in neck then (3) years ago. She did not seem concerned. Stated it was just placement in the neck, and I shouldn't be concerned. Ok. . .Am getting follow up blood work next week for thyroid panel and cholesterol. My weight is: 131.6 Lbs. I was diagnosed w/panic & anxiety years ago. Not on any meds for that since 2004. Could the bruit have been caused from the prescription Klonozapam, serz-one and Zoloft used over 7 year period? Or is it strictly cholesterol (diet related)? Family history of heart related issues. Do I insist on sonogram? No insurance -self pay. I have read a few posts regarding symptoms. I have a 'rush feeling' on left side of neck, I correlated w/panic & anxiety disorder. Blurry vision, neck stiffness, and equilibrium feels off . Doc prescribed calcium supplement & estrogen. Thank you.
bruit heard by stethoscope 2nd time in 3 years, self employed, McGregor, Iowa, USA, January 9, 2013

•Brian D -- thanks for your post. Actually interventional cardiologists are trained in a number of peripheral procedure as well: legs, carotids, kidneys, etc. The key word is interventional -- which describes a physician who possesses "catheter-pushing-skills". Surely some vascular surgeons are now trained in interventional methods as well, since half of many of their open surgical procedures are now done via catheter. Of course, you are right -- you want to see a doctor who is familiar with vascular issues, not just the heart -- but that doctor today may very well be an interventional cardiologist. We actually offer a documentary on this very subject, called "Vascular Pioneers: Evolution of a Specialty."
Angioplasty.Org Staff, Angioplasty.Org, December 9, 2012

• A general response - Cardiologists interventional or otherwise are heart doctors! If your having problems with your vascular system see a vascular M.D. / surgeon. Whether you need stenting or surgery they will be able to do far more for you then a heart doctor. Think of it this way any mechanic can work on your Mercedes but wouldn't an experienced / certified Mercedes mechanic be better? In other words would you let your electrician fix your plumbing?
Brian D, New York, New York, USA, December 1, 2012

• My husband has just been told he has an 80% blockage in his right carotid artery. His overall health is fine - he is slightly overweight. What are his best options?
Janabelleca, Saskatchewan, Canada, July 17, 2012

• Jody B in Oregon - Determining whether or not a blocked carotid artery is causing dementia, etc. is a complex issue. As for tests, etc. read our interview with Dr. L. Nelson Hopkins, especially the segment on carotid stenting.
Angioplasty.Org Staff, Angioplasty.Org, July 1, 2012

• Mother is 83 yrs.old. Hx. of vasculitis, shingles,CHF,hypertension (on Coreg),dvt, stroke with expressive aphasia, possible early dementia with memory loss which she acknowledges as well as frustration of not being able to consistently express her thoughts. The interventional cardiologist is suggesting work up to consider stenting an 80% blocked left Carotid A. She also has altered renal function. Unless this procedure can somehow improve her speech and reverse the dementia to some degree, I am inclined to question the benefits vs. the potential complications in her case. Am I off base in thinking this way? The pre-workup ECHO may show her to not be a candidate. Seems like the cardiologist would have already taken her overall health hx. into consideration before ordering a lot of tests. Thanks for reading this. I am concerned.
Jody B., Oregon, USA, June 27, 2012

• A small tear or dissection can heal by itself. Sometimes a dissection can also be treated with a carotid stent, or surgery. Here is a journal article on the subject from the Journal of Invasive Cardiology, titled "Endovascular Treatment of Carotid Artery Aneurysms with Stent Grafts."
Angioplasty.Org Staff, Angioplasty.Org, May 9, 2012

• I am a 43 year old female with a lifetime history of migraines and family history of brain aneurysms (two aunts have passed due to ruptured brain aneurysms and one cousin has recently had two brain aneurysms repaired). My most recent MRI/MRA and CAT w/dye revealed that I have developed a small aneurism in my interior carotid artery which resulted in a tear. Follow-up with vascular surgeon resulted in a daily 325mg aspirin regimen as it appears that the artery has closed itself back up but I still have a lot of neck pain. Is it common for the artery to repair itself?
Susanmia, Boston, Massachusetts, USA, USA, May 9, 2012

• Has anybody gotten pregnancy with a brain stent? My wife had a fistula behind her right eye diagnosed last summer and went in for an embolization in November. The procedure failed because they were not able to reach the fistula, so they tried again in December. They injected glue and blocked the fistula but unfortunately some glue escaped into her carotid artery and was thrown distal into her MCA. A significant amount collected at the MCA/ICA junction and later caused a significant stroke, at which time they stented the glue site at the MCA-ICA junction with a Wingspan stent. She has just passed the 3 month period from the stroke and stenting and is improving, but the question is whether there is additional risk of pregnancy moving forward due solely to the existence of the stent. We would like to have another child if it is physically safe to do so. The doctors we have talked to have said they do not see anything necessarily preventing her from having a baby, but of course our trust in the advice of these physicians is understandably compromised given all we have been through. She does not have other risk factors (low cholesterol, low blood pressure, otherwise very healthy, not overweight, etc). Any experience with pregnancy and a stent?
Oregano, Virginia, USA, April 14, 2012

• Thank you for your reply! As far as I can tell, based on Bio's, both 'vascular' Drs. specialize in interventional cardiology. He had an angiogram done of his carotids at a previous admission (different hospital), and angioplasty done on his R iliac artery, and his L femoral artery on this admission. From previous admission and angiogram, it appears that clots broke loose and sent mini embolisms to his feet, now resulting in loss of tissue on his toes. He has had CT's done as well, so many on his last admission that I am unsure if it includes his carotids. Thank you for your info. I will share with my mom the need for other consults before proceeding further. Thank you SO much for this site and replying.....we felt very lost and stuck on what to do!
Bridget, Olathe, Kansas, USA, March 21, 2012

• Ann in Alabama -- You have posted to a topic on Carotid Stenting, so we're not sure if you are talking about one having only main coronary or carotid artery. Could you clarify?

And Bridget in Kansas -- if by "spongy", your doctor meant "soft, lipid rich" plaque, then it has been shown that this type of complex plaque is more prone to embolization (breaking off of particles that can then travel to the brain, causing a stroke). One question is how has it been determined that the carotid contains this type of plaque? Has a CT, MRI or angiogram been done? Ultrasound, by itself, is not the definitive imaging test, according to Dr. "Nick" Hopkins (see his interview with Angioplasty.Org). So it is interesting that the other doc want to see an angiogram. Another question is what type of "vascular doc"? There are three specialties that deal with the carotid: vascular surgeons, interventional cardiiologists, and interventional radiologists. All three of whom perform carotid procedures, either surgery or stent, and each of whom have biases. Given the dialysis and blood issues, you might want to get opinions from a surgeon AND an interventionalist, just so you are reassured as to what the correct way forward is.
Angioplasty.Org Staff, Angioplasty.Org, March 20, 2012

• My 65yr. old father was just released from hospital, admitted for GI bleed, purple feet. He has a 90% blocked carotid, and 60-70% blocked carotid, also on peritoneal dialysis and missing 5 clotting proteins in his blood due to malnutrition. The vascular Dr. that did his iliac stent placement during this admission told my mom that my dad has 'spongy' plaque, also demonstrated to my mom that is has a wave like motion to it. He told her in his 9+ years of practice that my dad is only the 5th person he has seen with plaque like this. He has recommended that NO stenting or angiography be done on Dad's carotid's due to risk. My Dad had a stroke just before discharge and neurology suggested surgery to clean the carotid's out. I am trying to find information about this type of plaque and am not having any luck. When my Mom asked to see the vascular Dr. again prior to admission, it was one of the other practice Drs, that had followed Dad the most in the hospital, that came to talk with her and he recommended angiography to see what is going on. We are a little lost. Thank you for any information, just something to read would be helpful.
Bridget, Kansas, USA, March 19, 2012

• I was born with only one main artery, which narrowed and was closing off after every heartbeat! I had open-heart surgery, Dr repaired it with a vein, which right now keeps me alive!! Have you ever heard of this before and what, if anything, should be done!! I was told it would not last many years!! Thank you for any info!!!!
Ann (my middle name), Grant, Alabama, USA, March 16, 2012

• Sassy in England -- Your brother's situation is complex and something you should discuss with the specialist who cared for him. In some cases, a carotid stent can be used to reopen the occlusion, but this depends upon many factors, what the exact cause of the dissection was, etc. and really can only be addressed by a specialist in the field. Various specialties deal with the carotid artery: vascular surgery, interventional cardiology or radiology and neurosurgery. Treatments other than medical therapy are surgery or interventional (stenting). FYI, the body has a multiple blood supply to the brain with both a left and right carotid artery, plus collateral circulation, although obviously total occlusion of any vessel is not an optimal situation.
Angioplasty.Org Staff, Angioplasty.Org, March 2, 2012

• My brother had a stroke following carotid artery dissection. He has been told his right carotid is 100% blocked now. My question is what is the artery blocked with? Scar tissue? Is it possible to have another stroke from an artery 100% blocked or not? Thank you.
Sassy, Bournemouth, England, March 2, 2012

• Worried Mom in Fort Worth -- Your question should really be directed to a neurosurgeon -- not something that carotid stenting can probably address. We wish you the best and hope you are able to find answers.
Angioplasty.Org Staff, Angioplasty.Org, February 19, 2012

• My daughter at the age of 19 was in a SERIOUS wreck. Her internal carotid artery was torn in half, it is now completely closed off by scar tissue. Is there anything she needs to look for in the future? Possible long-term issues that may arise? I worry about this because it seems the less she knows about medical issues for herself the better she thinks she is. I told her to get a bracelet to notify if there was another accident and she won't because she thinks she is all fine. It was a miracle she lived through the wreck, I do not want to lose her now to something that could have been prevented and wasn't. Along with that, at the same time her diagnosis was Diffuse axonal injury and she thinks it is "gone away", well does it ever really go away or did her brain just lean to leave the damaged tissue alone and reroute the neurons and such to assist in her recovery? Thank you in advance.
worried mom of a stubborn kid, Fort Worth, Texas, USA, February 16, 2012

• Matthew -- You clearly have a complex medical situation. It would be difficult to say if your carotid artery narrowing is causing your various symptoms. We cannot give medical advice in place of a trained physician, but would certainly urge you to have your various specialists talk to each other about your condition. One specific issue about getting a carotid stent would be the need to take Plavix for 4-6 weeks after stenting. Since it sounds like you have some type of internal bleeding issue (black stool, etc.) Plavix could make this worse.
Angioplasty.Org Staff, Angioplasty.Org, January 1, 2012

• I have just been told last week that I have Congestive heart failure and my carotid artery is blocked 68%, and possibly colon cancer have very black stools with fresh red blood also so their blood down low they said and blood up higher. I have not told my family due to I don't even know if I am able to handle all this anyhow. But I also have PE, DVT's, Osteomyelitis in my jaw bone, heart Attack all with in the last 12 months not including my mercer, coagulated staph, and few other staph infections. I have been getting really bad headaches lost my appetite but am trying to stay focused and just keeping my head up. What should I do about this and is there any options. I have known something was wrong for while I just kept putting off because I have been unable to put on weight and I try everything but when you have no desire to eat that is hard, is there any advice you can give me stress or helping me sleep. Should get a few other opinions?
Matthew, Toledo, Ohio, USA, January 1, 2012

• Hi, I'm 51yr old female, had a shunt put in the carotid vein in the neck, November 2011, am experiencing burning sensation in the side of the neck and slight dizziness, is this cause for concern?? maybe someone can answer for me. Thanks Debbie
Debbie, Bolton, Edenvale, Gauteng, South Africa, December 29, 2011

• Bunny in Michigan -- Atherosclerosis (narrowing of the arteries) is a systemic disease. So the same chronic condition that caused your husband's heart attack is also responsible for the narrowed carotid arteries. Reducing modifiable risk factors is of primary importance: smoking cessation, diet, exercise, stress reduction, etc. AND taking the medications prescribed by his cardiologist (statins, etc.). You state that he had "heart surgery" and that he is not considered a candidate for "carotid surgery". Do you mean he had actual surgery (for example, open heart bypass graft surgery) or was it angioplasty (which technically is not surgery)? Has he been evaluated for carotid stenting? And if he is not a candidate for this procedure, why not?
Angioplasty.Org Staff, Angioplasty.Org, October 21, 2011

• my husband is 51 last year he had a major heart attack, his I'm not sure if it was blood flow or Ejection fraction but before surgery it was 8% leaving him with an ICD and pacemaker with a lot of damage, he was on a L-Vad machine 8 days his Ejection fraction is 25% one year after, now he has a 90% blockage in right side and 30% in left carotid artery, he is tired all the time, dizzy, forgetful, they say he is not a candidate for carotid artery surgery he came out of heart surgery with nerve damage in left arm, he's insulin diabetic 2 shots a day since he was 8 yrs old, his blood pressure runs low, all the Doctors say is he is a miracle, and severe damage, they have never told me how long he may have,and i have never asked in front of my husband, we both know its not good,,but i know what he was before,,and i see what he is now, i know nobody but god knows your day and time, but due to all the damage,,what kind of time period can we be talking about, I truly believe he has some kind of damage from all this,,he is so different,forgetful,,irritable,,and very argumentative, nothing like he was before,please don't hold back, i know its not good,,i need to know what to expect, I am his caregiver.
Bunny, housewife and caregiver, Michigan, USA, October 18, 2011

• Had surgery on left carotid artery which was 70% blocked, After 6 months I still have swelling in the jaw and neck on the left side. Another MRA was done and revealed 50 to 60 % blockage although the the surgeon feels it is 25% but the swelling continues. Anyone else with this problem?
Louis Hopkins, Lutz, Florida, USA, August 8, 2011

• Heart and Carotid Disease in Texas -- check out the second part of our interview with Dr. Nicholas Hopkins. Ultrasound can sometimes be inaccurate in the diagnosis of carotid artery disease. Dr. Hopkins feels CT is the better diagnostic test. It's not that you have no stenosis, but it's been judged minor enough to be not problematic. Perhaps give your cardiologist a bit more time (maybe he/she is attending the ACC.11 meeting this weekend! And please write back to let the Forum know the outcome.
Angioplasty.Org Staff, Angioplasty.Org, April 2, 2011

• I had a Duplex ultrasound (bilateral Carotid arteries), the results came up as 50-69% stenosis in the left carotid and less than 50% in the right. I followed up with a Carotid CT Angiogram (with Dye). The radiologists said that both Carotid were 'Unremarkable'. How is this possible that between two proven tests, there is such a difference (going from 50-69% to no stenosis?). Please advise as the cardiologist isn't responding to my calls. Thanks in advance
Heart and Carotid disease, Texas, USA, April 2, 2011

• Saila -- Atherosclerosis is a systemic disease of the blood vessels. This same disease caused your heart attack, as well as your carotid blockage. Lowering risk factors (smoking, exercise, diet) can reduce the progression of this disease. Modern medications are also very effective in lowering cholesterol, blood pressure, etc. When a blockage occurs, angioplasty can open that blockage up and relieve symptoms. Some people have a totally occluded carotid artery, but there are actually two sets of two carotids. However if a 90% blocked carotid can be treated, that's a good thing. As for your coronary artery -- it depends on where the blockage is, what part of the heart it feeds, etc. before a cardiologist can determine if opening up that blockage will really have a positive effect. Some studies have shown no benefit in opening up such a blockage post-heart-attack. We would recommend going over your angiograms with an interventional cardiologist and discussing your situation.
Angioplasty.Org Staff, Angioplasty.Org, January 7, 2011

• I had a heart attack in April 2010 in Saudi Arabia at the age of 74. To determine the extent of blockage in my heart, a month later I had an angiogram in Tehran where they told me that my right carotid artery was 90% blocked and I could have a stroke. They also figured that the blockage in my carotid artery required a more urgent attention than my heart. Five days later, they put a stent in my carotid artery. I'm confused and also glad to hear as I read here that people whose carotid arteries have been 100% blocked have had no stroke. What's the answer please?
Saila, Glendale, California, USA, January 6, 2011

• Kahssy -- Unblocking the carotid artery is done to increase blood flow to the brain and possibly avoid stoke in the future. High or fluctuating blood pressure has many causes, and treatments. You should definitely discuss this issue with your dad's cardiologist, if you haven't already, to try to bring this under better control. Carotid artery disease is atherosclerosis in the carotid artery. The same disease process can also affect other arerials systems, such as the leg, coronaries and even the renal arteries in the kidneys -- the renals actually have a lot to do with blood pressure -- a novel treatment is just now being explored where a catheter is inserted in the renal arteries to "denervate" the renal nerves and successfully get uncontrollable high blood pressure under control.
Angioplasty.Org Staff, Angioplasty.Org, December 8, 2010

• My dad just recently had his carotid artery stenting procedure on both arteries. i was expecting that his blood pressure reads normal days after the procedure, but unfortunately it didn't. his blood pressure still fluctuates and goes up specially during night time. is this normal considering that the procedure is successful? or what could fluctuating blood pressure mean? when shall we expect to have his blood pressure stabilized?
Kahssy, Philippines, December 8, 2010

• Ms. Janet -- We're not clear on the results of your tests. You say you were diagnosed as having had a TIA, that your carotid is 70% blocked, yet the CT was normal? How did they determine that your carotid is 70% blocked if your CT was normal? Read our comment below from November 30 about imaging and diagnosis of carotid disease. We would recommend seeing a vascular specialist, as noted in that comment, as well. Also we don't understand the 90% rule mentioned. Currently Medicare covers symptomatic patients (a TIA would be considered a symptom) with blockages of greater than 70%, but again, your diagnosis is not clear to us. That's great that you've had this weight loss, although that is a lot to lose in that short a time -- wonder if there's any connection there?? Try not to panic. A proper diagnosis will guide the correct treatment, assuming any is needed at all. When you've seen a specialist and found out more, please let the Forum know the results.
Angioplasty.Org Staff, Angioplasty.Org, December 1, 2010

• I am 48 years old and the Drs. told me yesterday when I was rushed to the ER with numbness and tingling on my right side that I had a TIA. They kept me overnight and I had test ran, they found out that my Carotid artery is blocked 70% and they said my CT scan came back normal and because I had epilepsy when I was young they gave me a procedure to check to see if I had any waves showing seizures. It was normal. They don't want to perform a procedure to open the Carotid Artery because it has to be 90% blockage. Well my problem is that I keep feeling these weird feelings in my right side and wonder if I'm going to stroke out or if I need to have a second opinion. I am on blood pressure meds.I've had stress test and heart cath all came back normal. I also get headaches on the right side(not severe) but bothersome. I stay dizzy. I don't want to be walking down the street with my 10 year old and fall out with a stroke. I've lost 50 pounds in 3 and a half months I try to eat right I don't exercise a lot but I do walk often. Can someone tell me anything. I'm just scared. It has caused me to have anxiety and panic attacks with thoughts of dread and dying all the time. Any help or comments?
Ms. Janet, Texas, USA, December 1, 2010

• Ajababy2 (good name) from California and Juan C. from Texas -- check out the second part of our interview with Dr. Nicholas Hopkins. He's the head of the Toshiba Stroke Center in Buffalo, New York and one of the country's leading experts on carotid artery disease. He's both a surgeon AND an interventionalist who places stents, so he's got all therapies covered. The bottom of the page is specifically about what is the best imaging method to diagnose the percent of blockage -- he feels that a CT angiogram is superior to Doppler and even MRA -- and that an intervention should not be ruled in or out until a CT is done. Juan -- when your doctor says "occluded" did he give a percent? and Ajababy -- the Doppler is not nearly as accurate as a CT. But with your concerns, initial Doppler imaging diagnosis, and family history, you should consult a vascular specialist, preferably at a center experienced with both open surgery (endarterectomy) and carotid stenting. Get a better diagnostic imaging test and then discuss your options. Medical therapy has advanced greatly in recent years. Also the recent data from the CREST trial showed good results from stenting, as good as surgery, especially in younger patients. But consult a specialist (interventional cardiologist or radiologist, or a vascular surgeon -- preferably a center where all work as a team).
Angioplasty.Org Staff, Angioplasty.Org, November 30, 2010

• i had carotid doppler today and both of my arteries are more than 75% blocked. My brother just has a stent. his doppler said he was 60% blocked but ct scan said 90% blocked. I am 52 yr old female. my ct scan is 11/16. i am totally freaked as i am single mom to 10 year old and take care of my 90 yr old mom. four of my mom's siblings have been affected by this, two resolved with surgery, another died of massive stroke right after surgery, and another died of massive stroke undiagnosed. my paternal grandmother also died of stroke and my father died of heart attack at age 56. any input from anyone would be most appreciated.
ajababy2, Victorville, California, USA, November 12, 2010

• Recently had a severe headache at a very inappropriate time. Went to the doctor as my head continued to hurt, got an MRI/MRA and was told occluded left interior carotid. Did not get a definitive answer how this affects my future life other than "don't let a chiropractor adjust your neck". Always been healthy, athletic and active and now am a bit paranoid. Other than a bout with testicular cancer at 40 and chemo, (which I was told my body handled extremely well) always been extremely healthy and never take ANY medications. Anybody got any info how this will affect my life? I just turned 55 and don't know what to expect or what I should avoid, what to be aware of, etc. I'm not ready to surrender.
Juan C., Tyler, Texas, USA, October 25, 2010

• Hi We just got home from the hospital and we are exhausted. My husband Jerry has a 100% blockage of both carotid arteries and the Dr's said they could not operate on him. They said the two smaller arteries in the back of his neck have taken over. The Dr's said this is very very rare, they seen it once 18 years ago. Is anyone out there that has heard of this and what can we do. We are scared, they told us to take the medicine they have prescribed , exercise, eat clean and go about your life, but I as Jerry's wife am worried about our future. The hospital is an excellent hospital, that specializes in Heart and Vascular. Any help would be great. Thank you
help jerry, just a caring wife who needs help, Tiffin, Ohio, USA, July 9, 2010

• Dec 2008 I suffered from a stroke due to occlusion of the right internal carotid artery. October 2009 CT perfusion test showed complete occlusion of the right internal carotid artery 1.4 cm above it's origin. Any chance it will get better? Thank you
Sara, Xenia, Ohio, USA, February 22, 2010

• I am a 49 year old female who just suffered a left internal carotid artery dissection which caused several small strokes. The vascular surgeon could not repair my artery it was greater than 95% blocked and too high in the brain to be fixed. I went back for my 3 month MRA and the artery had repaired itself greater than 50%. I will return in 6 months I expect to find the artery 100% repaired. Has any one had this type of experience? By the way my cholesterol, tri-glycerides are perfect!!!!!!!!!!!!!
MH, Kentucky, USA, February 9, 2010

Steven J from Florida. I am a 32 year old female marathoner who was born without a right internal carotid, had a severe car accident two years ago has a stented left internal carotid artery. It is a catch twenty-two for us. Either we fight for our lives everyday by eating right and moderate exercise or we build up plaque, high blood pressure and anxieties by staying on the couch. We have to live with fear everyday and find a positive in it! This stinks most days!! However, we don't have a choice anymore. I understand, I TRIsected my artery and had a stroke. I had 100% blockage before I was saved. It scares me every moment of everyday! However, you have to get up and fight. If you need any support I am hear to listen!! I am here for anyone for that matter. This is a heart breaking site yet its nice to know we are all here for the same reason...hope, support, and knowledge.
Joey, California, USA, January 18, 2010

• I had a carotid endarterectomy in August 1999. Recently I was told that I have 70% blockage in the artery I had surgery on and 60% blockage on the other side. My doctor say these can be treated with stents. My question is, can both stents be put in during the same procedure or will it require a separate procedure for each side.
Ramona, Rogersville, Alabama, USA, January 12, 2010

• My 88 year old father had a mini stroke (TIA). It turns out he has been having a series of small strokes because his left carotid is 60% blocked. He is already on Coumadin, since he had a double by-pass 3 years ago this month. At the hospital they say he may not need surgery since they normally do not recommend it if there is less that 80% blockage. The other alternative they present is drug therapy -- assume they mean to increase the coumadin. Are we limited to those 2 options.My father is in fairly good health his heart is strong.
Lili, Miami, Florida, USA, December 10, 2009

• my right artery in my neck is 100%blocked and my left about 50% i had a TIA after the op it has left me with real bad panic attacks my right eye the vision goes weird and the right side off my face is cold and goes numb will this get better in time i did smoke i am 56 diabetic i have a few health probs.
Margurita , Preston, England, October 14, 2009

• 2 years ago a had a left internal carotid artery dissection, it healed but developed a pseudo aneurysm 6mm by 11mm. My last 2 MRA's showed a stable aneurysm, no better and no worse. I am due for a 2 years scan in Sept. My doctors say no more roller coasters, sky diving, bungy jumping or things that my twist or snap my neck. (never did any of that anyways)I am 57 years old male and other than BP meds I take a 81mg aspirin a day. Any comment on long term effects of the dissection on life style word be greatly appreciated. I have been reading your forum for 2 years and enjoy it very much.
B. Lammers, Ocala, Florida, USA, July 16, 2009

• RS -- two types of doctors can treat blocked carotids: surgeons, usually vascular surgeons, who perform an open surgical procedure called Carotid Artery Endarterectomy (CAE) -- or -- an interventional cardiologist or radiologist, who perform an interventional procedure usings a stent called Carotid Artery Stenting (CAS). Each has aspects that may or may not be more benficial in your father's case. You might want to check with specialists in both areas before deciding.
Angioplasty.Org Staff, Angioplasty.Org, July 15, 2009

• My 82 year old father's right carotid artery is 100% blocked and his left is 70% blocked. He has numerous strokes and TIA's. Can surgery be done and if so how risky is surgery? We have been told not many doctors will perform this surgery.
RS, Brooklyn, New York, USA, July 1, 2009

• After suffering 2 strokes within a couple of years it has been discovered that he was born with only one carotid artery! How common is this, and is it a genetic defect likely to be present in brothers and sisters?
Jon Bruce, Palm Springs, California, USA, June 22, 2009

• My husband is 29 years old and just learned that he has a blockage of the carotid artery. The doctors have not yet given us much information other than that the probably has had this for a long time, and it could be caused by a trauma. Does anyone know if this is treated the same way as if you have carotid artery disease?
NF, Michigan, USA, June 12, 2009

• Liz -- total occlusions of the carotid artery are not usually candidates for re-opening (called "revascularization") either surgically or using stenting, for a number of reasons. Fortunately, we all have two carotids (left and right). It's important to have the 100% occlusion verified by an angiogram, not just ultrasound. Have you gotten a second opinion? For example, if you saw a vascular surgeon, maybe consult with an interventional cardiologist, and vice-versa. You can read more about carotid stenting in our interview with carotid stent expert Dr. Christopher J. White (coincidentally at the Ochsner Clinic in New Orleans).
Angioplasty.Org Staff, Angioplasty.Org, March 22, 2009

• My grandmother has had 5 mini strokes(TIA) in about a 2 week span. she is only 59 but her left ICA (internal Carotid artery is 100% blocked from her neck to her eye. and the doctors don't really sound too hopeful about her situation. And from what i understand they can't operate on patients with 100% blockage. Is there any chance of getting better or do her loved ones have to just wait til a major stroke comes along and kills her or just slowly watch her die a painful struggle?
Liz, New Orleans, Louisiana, USA, March 20, 2009

• Est -- not sure the effect of the simulated nicotine -- but your doctor should be able to help you here. 40% is at the point where lifestyle changes (somking cessation, exercise, diet) and medications can help at least stabilize (and possibly reverse) the progression of disease (remember, carotid disease is the same disease as coronary artery disease, just in a different vessel).
Angioplasty.Org Staff, Angioplasty.Org, January 29, 2009

• I am 47 I have 40 percent carotid artery blockage on right and left side is there anything I can do to reverse the blockage I am trying to stop smoking but i still use a nicotine simulant. is this okay?
Est, Alabama, USA, January 22, 2009

• I am a 26 year old female with a 90% blocked right carotid artery. Doctors are baffled and are not sure of the cause - whether spontaneous injury, vasculitis, etc. I experience tingling in my right fingers and in my lips and tongue. My right eye also is almost always twitching, sometimes for weeks at a time. Most of what I've read, and what a majority of doctors tell me is that a blocked carotid may result in a lack of sensation, such as numbness or paralysis, but not a positive sensation, such as tingling. I truly believe and have a gut feeling that they're connected. Does anyone know anything on this? Much appreciated.
Tiffany, Connecticut, USA, January 7, 2009

• Tanya -- the Mid-America Heart Institute in Kansas City has a long reputation in endovascular procedures and might be able, if not to treat you, to at least refer you to a closer center.
Angioplasty.Org Staff, Angioplasty.Org, December 29, 2009

• I am a 61 year old female. I have had endarterectomy on both sides of my neck. The first one in 1998 and the second one in 2003. They are both 60% blocked again. I had TIA's after surgery. I would like you to advise me, who is a expert in carotid stenting in the Kansas area that I could speak with. I am scared of having a stroke and would to talk to a expert about the stenting, before i get in trouble.Thank You.
Tanya Kimzey, Salina, Kansas, USA, December 23, 2008

• Arlene -- these questions are very specific as to the patient. It's not really possible to advise you over the internet, but you should ask these questions of your brother's doctor. We are assuming he was evalutaed by a vascular surgeon. If you want a second opinion, you might want to consult an interventional cardiologist who is expert in stenting. Since you are in NYC, you might want to call Lenox Hill Hospital and speak to Dr. Gary Roubin who is an expert in carotid stenting.
Angioplasty.Org Staff, Angioplasty.Org, December 18, 2008

• My brother was just told that his carotid artery operation 6 months ago didn't work it is 100% blocked. Before surgery it was 80% blocked and they cannot operate on it. He has no ill symptoms they did not put him on medicine the dr said he should continue on his normal regime. My question is what is it blocked with? If it is a blood clot can it travel and since it is blocked and the other side is ok is he still in danger of having a stroke or would he have had one already when it became 100% blocked.
Arlene, New York, USA, December 17, 2008

• I am a 71 year old male. There is a 50% stenosis of the right common carotid artery. What can I do to prevent from further blockage?
Bob Quinn, Scranton, Pennsylvania, USA, September 28, 2008

• My name is Patty, I am 46 years old. Last week I suffered a mild stoke. After all the testing that was done, they say my left, Carotid Artery is 100 percent blocked. Sent me home with blood thinning medication (coumadin). And Lipitor. Told me to set up an appointment with a specialist in two weeks. Now I have no insurance, so I'm pretty sure this specialist won't be seeing me, since I live off of $695.00 a month. All I guess what I'd like to know is. Am I still supposed to be planning to live to see 80?.... Or can I drop at any given time due to this illness? Thank You.
Patricia Emerick, Cumberland, Maryland, USA, June 14, 2008

• I have 2 strokes in 9-10 months ago I am 39. my right carotid 95% and left carotid is moderate to severe starting at the skull base. There is no surgery; only medication. I have speech dysphasia. So, this is hard for me. I have to take Coumadin for the rest of my life, because he said there is nothing that I can do. Is that true?
Jill B., South Carolina, USA, May 31, 2008

• My father is 78 years old, and just had I mini stroke (TIA) last Wednesday. My father lives in Puerto Rico. The doctors in the hospital did all kinds of test and evaluated him for 5 days. They said, that they had to operate right away but now, they decided not to operate, and sent him home. He has 60 and 75 percent blockage in his Carotid Arteries. The doctor put him on a higher dose of the medication he was taking. I am so worried and scared, I feel that they are sending my father home to die. My father's left side is a litter numb and he can not walk correctly due to the TIA episode. Please advise...are these the correct steps taken by the doctors. I don't know what to do, and I feel helpless. Thank you.
Madeline, New York, USA, May 27, 2008

• Pamela -- we'll refer you to the second part of our interview with Dr. Nicholas Hopkins, head of the Toshiba Stroke Center in Buffalo. He discusses what type of imaging they use to confirm diagnosis and extent of carotid disease, and also the various specialties that deal with carotid disease. Hopefully that can clarify some of your questions. (It's his feeling that a multislice CT is the most accurate imaging test.)
Angioplasty.Org Staff, Angioplasty.Org, May 22, 2008

• My mother was told both her carotid arteries are 100% blocked; Sonogram revealed this, this morning, and immediately thereafter, a "STAT" MRA verified the same. Will her posterior auricular arteries provide sufficient blood flow? Can you unblock 100% blocked carotids? Needless to say, we are panicked. Her own mother and great-grandmother's died from strokes. Please, does anyone have any advice here?
Pamela J., California, USA, May 19, 2008

• Barbara -- our thoughts go to you. There is, of course, a complication rate with any medical procedure. Recent studies, such as the SAPPHIRE trial, have compared carotid surgery and stenting and have found that the risk of stroke is similar, around 6-7%. An ongoing trial, called CREST, is much larger and will hopefully give a clearer picture of these two therapies. There have been articles written about a possible increased risk for carotid stenting in octogenerians, due to plaque being more "friable", easily broken or dislodged in these patients. Of course, counter-balancing this statistic is the trauma that comes from an open surgical procedure, anesthesia, etc.
Angioplasty.Org Staff, Angioplasty.Org, May 7, 2008

• My 84 year old mom suffered from 90% carotid blockage and had the CAS procedure on May 1st of this year. Unfortunately, something dislodged from the procedure and my mom suffered a stroke when being moved from the bed. Today is almost a week & my mom is still on a respirator, unable to open her eyes or move her right side. Please pray for Ann because we still want to bring her home.
Barbara Bopp, Poughkeepsie, New York, USA, May 7, 2008

• Sheila -- whether or not your husband is a good candidate for surgery is something only his doctors can decide. If he is not, carotid stenting is an option (specifically for patients whose clinical condition may preclude an open surgical procedure).
Angioplasty.Org Staff, Angioplasty.Org, April 20, 2008

• My husband had a ruptured brain aneurysm in 2003, he had an AVM surgery in 04, his doctors just found out that his right side is 100% blocked and the left is 30% blocked. I am taking him to his neurologist to see if he is a candidate for surgery? he is weaker, than he was after his AVM surgery. right leg, left arm, are the weak ones. Do you think he has a chance for any surgery?
Sheila Garrett, Springdale, Arkansas, USA, April 18, 2008

• Bud -- a lot has been written about total occlusions in the carotid artery. One the occlusion is total, it's usually left alone, because intervening to try and open it up may cause more problems than not doing anything, especially if you have collateral circulation. Also you have another carotid artery on the left. Was this vascular surgeon the physician who did the carotid stenting? If not, you might want to discuss your situation with the interventionalist (vascular surgeon, cardiologist or radiologist) who did the stenting.
Angioplasty.Org Staff, Angioplasty.Org, April 8, 2008

• Age 76. Right carotid endarterectomy in 2002, stent there in 2003 for restenosis, angioplasty there in 2004 for restenosis inside the stent. Then OK until Dec. 2007, when angiogram showed 100% blockage. Vascular surgeon says this is OK because I am asymptomatic and therefore must have developed adequate collateral blood supply. Is there literature on this?
Bud P., Chicago, Illinois, USA, April 6, 2008

• just had a stent in the carotid artery 3 weeks ago at cleveland clinic..all went well! but i am a type 2 diabetic and readings (a1-c) are higher then they were 6 months ago.. also i am very tired all the time hard to exercise at all. i am 60 years old , anyone have the same procedure and how is it affecting you????
Della, Ohio, USA, April 3, 2008

• Ben -- the laboratory that did the blood testing may have a glossary of terms. A company that does blood tests directly for patients has a useful list of terms. Try HealthCheckUSA.
Angioplasty.Org Staff, Angioplasty.Org, April 2, 2008

• Recently had an Ultrasound on my Carotid's. Verbal report from Doctors office said no major problems and they forwarded the "Carotid Duplex Report" to me. All the blood work reports I have received in the past show acceptable range and you can tell where you stand. This report has ten items for each side, almost all abbreviations and I cannot find out what they mean or how good or bad each one is. Is there a web site or something that breaks this report down in laymen's terms?
Ben H., Oklahoma, USA, April 1, 2008

• Sandy -- we are not MDs and, as our disclaimer states, nothing on these Forums (or on our web site) should be taken as a substitute for medical advice from a licensed professional. That being said, we call your attention to part two of our recent interview with Dr. L. Nelson Hopkins, one of the leading experts and pioneers in the field of stroke and the use of imaging for diagnosis. In discussing how to diagnose the need for carotid surgery, he concludes: "...certainly never rely on ultrasound alone to allow somebody to operate on your neck. That’s just not a good thing to do." But you should read the whole interview (part two, anyway).
Angioplasty.Org Staff, Angioplasty.Org, April 1, 2008

• I am a 42 year old female. I have been having trouble walking and was diagnosed with Vascular Disease and have 85% blockage in my legs, by ultrasound and CT Angiography. Also had ultrasound on my carotid arteries and was told right side is 90% blocked and left is less than 40%. No other test on my carotid arteries was done. Had a coronary cath for cardiac clearance in order to have surgery. Heart is clear I am scheduled for a carotid endarterectomy this week and wanted to know, should more tests have been run before jumping to surgery? After the carotid is done they will fix my legs. I am in good health otherwise and have 2 small children. What should I be doing to ensure that surgery is the right option? Thanks.
Sandy, Florida, March 31, 2008

• Linda -- when the doctors say an "operation" are they discussing doing an open procedure, called carotid artery endarterectomy (CAE) where the neck is opened and the arterial blockage is "scraped out", or the newer endovascular procedure, carotid artery stenting (CAS), which in experienced hands has been shown to be of equal effectiveness in the proper patient population? The open surgery is done by a surgeon, usually a vascular surgeon. The stenting is usually done by an interventional cardiologist and does not require an open incision -- it's done pretty much the same way a coronary stent is done and the patient is usually discharged the next day. Stenting is often done when the patient is not a great candidate for surgery, due to age, clinical situation, etc. The morbidity/mortality stats for both procedures are pretty much the same. By the way, one of the pioneering cardiologists for carotid stenting is Dr. Gary Roubin now at Lenox Hill Heart and Vascular Institute of New York, but previously was head of cardiology at U of A, Birmingham!
Angioplasty.Org Staff, Angioplasty.Org, March 25, 2008

• Just found your site not sure hot it works but I need answers!!! My father 76, a hugh workaholic, farmer, and retired electrician, had his second stroke six months ago. The first stroke at age 55. He made a full recovery and resumed working. At age 65 he had quadruple heart bypass surgery to clear clogged arteries around his heart. Since then he's had several stints [stents] placed around his heart. Again, full recoveries and resumed working. The Dr's say this last stroke caused 90% carotid blockage on the right side and 70% on the left side. He's had the ultrasound and Angiogram as well as other test. The Dr's didn't want to operate, even though his heart Dr said his heart could handle it. My father asked "What do you want to do? Just throw me away to die?" Now, the surgery is April 3rd and I'm worried about the complications. Why did they not want to operate but now will operate? Before this last stroke, my father was strong as an ox and very active. He's been a workaholic his entire life. He's changed his diet, and is on blood thinners, cholesterol meds. aspirin etc. Why can't they open both sides during the same operation? What is the likelihood of another stroke or death during this operation? I live in Alabama and he's in Pennsylvania. Should I plan to be there for the surgery or are these surgeries normally routine?
Linda, Birmingham, Alabama, USA, March 25, 2008

• Doris -- stents are not going to keep your carotids from reblocking any more than surgery. Although a major trial is ongoing, to date both procedures are pretty equivalent. What you need to do is reduce as many risk factors as possible -- and smoking is most definitely a big one! It has been proven that smoking increases the risk of injury to the artery walls throughout the body -- heart, carotid, legs, renals, etc. And that injury is what causes the blood and cells to try and "heal" the injury -- causing a blockage. We are very aware that It IS hard to stop smoking -- cigarettes ARE addictive. We strongly suggest you enroll in some type of smoking cessation program -- your doctor may be able to help. It's the first step, but a big one in helping your body heal itself. Let the Forum know if you find a good program. Write back here for support if you want. And Good luck.
Angioplasty.Org Staff, Angioplasty.Org, March 24, 2008

• I am a 57 year old female with no know illnesses except carotid blockage in both sides of neck. In 2004 had surgery on left side, then in 2006 had surgery on my right side. Now 2 years later my right is 90% blocked and my left is 50%. With the 2004 blockage I had TIAs -- this time no signs at all. I am hoping for stents, and a reason these keep blocking. Dr. says quit smoking. I know it’s no good but I don't think it is causing the blockage. Any info appreciated....
Doris H., Kentucky, USA, March 24, 2008

• Rita L. -- you can search the web for journal articles on "carotid artery dissection", etc. (by the way CAD usually stands for "Coronary Artery Disease") and that's certainly helpful to inform yourselves. But a complex question like yours is really something a specialist in this field can best answer. We try not to get into recommending doctors, hospitals, etc. for obvious reasons, but there's a new type of cross-specialty hospital/institute around that deals in vascular care -- whether it's heart, carotid, peripheral, renal, etc. And they have interventionalists, radiologists, cardiologists and surgeons in the same practice and sharing the financial end, so theoretically there's not a "competition" for the patient -- you'd get a stent, or surgery, or medical therapy, depending on what YOU need, not on what the doctor knows how to do.

Lenox Hill Heart & Vascular Institute in NYC is one such entity that we'll soon be profiling (disclaimer -- Lenox Hill provides some support for this site, although the Forum is independent). Dr. Gary Roubin at Lenox Hill is widely considered one of the foremost pioneers and experts in carotid stenting. We also know of the Baptist Cardiac & Vascular Institute in Miami. We've interviewed Dr. Barry Katzen there a number of times (it's also closer to home for you). There are other such Vascular Institutes across the country. Perhaps a call to Miami might get you the names of some physicians closer to you. Good luck and let us know how you make out.
Angioplasty.Org Staff, Angioplasty.Org, February 24, 2008

• To Forum Editor. You recently responded to my husband Bill, re: internal carotid artery dissection ( CAD ). I understand that you cannot advise medically, however perhaps you can guide us to information. We are looking for any studies/ articles, about CADs and resulting pseudoaneurysm. Treatment options: medical management vs. surgery, vs stent placement. History of others who have undergone the various treatments. Also, what hospital / doctors in the US have the most experience in this field? How do we find this information? I appreciate any guidance you can give. Many thanks.
Rita L, Florida, USA, February 24, 2008

• Bill -- carotid stents have been used for some time to treat dissections. And Mary -- both of you are describing a complex situation. We can't and don't give medical advice, but can only suggest that you consult BOTH a vascular surgeon and also either an interventional cardiologist or radiologist who has significant experience in carotid stenting. Perhaps you already have.
Angioplasty.Org Staff, Angioplasty.Org, February 23, 2008

• I am a 56 year old male, in relativity good health (I am no athlete) never smoked and only am an occasional one glass of wine drinker. I suffered a left, inner carotid artery dissection for no known reason. All other test were fine, stress test, chest X-ray, CT, MRI, MRA. (except for the dissection) All arteries clear. I spent 11 days in the hospital, had a catheterization, placed on heparin and sent home on Lovenox and coumadin. Several months later a CT scan showed the artery had healed but a pseudoaneurysm, maximal diameter of 8mm and 12mm long had developed. I also developed Horner's Syndrome. I will have another CT scan 6 months after the last one to see if there are any changes, good or bad. The doctor has me on my BP meds and 1-81mg aspirin. Also I am not allowed to lift more than 20 pounds, no quick head movement or blows to the head/neck. (no more roller coasters, bungie jumping, sky diving loss here) One doctor says have a stent put in and one says if it does not change, leave it alone and treat with meds. Just not sure what to do?? Will a stent give me my life back, that is do "most" of what I could do before the injury. Also, what are the risks of a carotid artery stent?
Bill L., Florida, USA, February 23, 2008

• i am 48 and have blockages in subclavian and carotid arteries. i have bovine arc syndrome, which means my arteries are the same as a cow or a sheep. i have systemic sclerosis, which doctors say account for my artery disease. i have been advised not to be operated on as i may suffer stroke or bleed to death. i am taking no medication for my artery blockages and am so terrified i am afraid to sleep.
Mary, England, February 22, 2008

• Denise -- a couple clarifications. First, the term "surgery" usually refers to an open surgical procedure. For the carotids, this would be called "endarterectomy", where the neck is opened, the artery dissected and cleaned out, and then closed. Stenting is a non-surgical alternative treatment, done in the cath lab without general anesthesia.

Second, DES (drug-eluting stents) are not used for carotids, because the carotids are so wide, compared to the coronary arteries, that restenosis is not the issue. What is important is that embolic protection devices are used (they catch any emboli that get dislodged during the stenting, trapping them from going upstream to the brain) and that the operator is experienced in this procedure. See our posts below, but we (and many physicians as well) recommend that you consult BOTH a vascular surgeon AND an interventionalist (a physician who works with carotid stents). 60% is considered borderline, but every patient's clinical situation differs. Read our interview with Dr.Chris White of the Ochsner Clinic in New Orleans for some baseline info.
Angioplasty.Org Staff, Angioplasty.Org, February 11, 2008

• My father has 60% blockage, I saw the image it looked like more to me but the Dr. said 60%. He has the option to get angioplasty done or not to. He is diabetic, he just needs one done on his right side. I am not sure whether to request no DES or DES. I read how DES can help prevent restenosis but at the same time the drugs it's releasing may cause some side effects like itching or aching plus the threat of stent thrombosis in the later stages. So I guess this means he should remain on plavix and aspirin forever because like heck if I want my dad to die of blood clot. Maybe he doesn't need this surgery. Maybe all he needs to do is a 180Degree turnaround for his diet. This surgery sounds like there are so many possibilities for complications that his standard of life maybe better off taking chances by diet change and plavix w/aspirin. He's had two strokes so far. both resulted in no damage. He's lucky and he knows it but his dr.s are saying this surgery would be the best option. I don't know if that is so true after reading all of this. has anyone here gone through the surgery with about 60% blockage for one stent? Anyone in a similar situations that might be able to help my father make his decision?
Denise, California, USA, February 11, 2008

• This post is for Steven J. in Florida that posted on Sept 14, 2007. Please email me. I would like to discuss our similar injury and treatment. Thanks.
Bill L., Florida, USA, February 11, 2008

• Onya -- a total occlusion in the carotid is usually not dealt with for a number of reasons. But there are two main carotids, right and left. Certainly you'll want to continue to monitor the open right one. Also make lifestyle changes and comply with prescribed medications. As we have written to others, if you have questions or doubts, consult BOTH a vascular surgeon AND an interventional cardiologist or radiologist who is experienced in carotid stenting as to the best treatment options and prognosis.
Angioplasty.Org Staff, Angioplasty.Org, February 11, 2008

• Just found your site not sure hot it works but I need answers!!! My husband 59, in good health. Six years ago had cancer to right tonsil (smoked few years as a teenager, good lifestyle for years). Couple weeks ago had TIA's which led to ultrasound showing 100% carotid blockage on left, right is open. Angiogram done to confirm. We're told can't do anything but like said, diet & blood thinners. Radiation oncologist NEVER mentioned to monitor. So now what do we do? I am so afraid of losing him and it could have been prevented, I cannot accept "nothing." He is healthy as a horse, many goals and living to do, we're both depressed and weepy. Will see surgeon who said "bad luck" in a few days.
Onya K., California, USA, February 11, 2008

• Several responses here, but first to Charles in Germany (immediately below) -- Congratulations! You didn't just find any carotid artery specialist -- you found Prof. Horst Sievert, one of the world's experts in this area. He was a fellow at Frankfurt of angioplasty pioneer Prof. Martin Kaltenbach, who performed the world's second coronary angioplasty. Profs. Sievert and Kaltenbach were both recently in attendance at the 30th Anniversary of Coronary Angioplasty celebration in Zurich. In fact Dr. Sievert is in the U.S. this coming Monday, chairing a full-day panel on the topic of "Peripheral Interventions" at the CRT 2008 meeting in Washington. We are very pleased that you were able to avail yourself of an interventional (stenting) solution. From what you told us, yours was exactly the case that this option was invented for -- patients who have been refused surgery. By the way Charles, recent data that's come out of ongoing trials shows that carotid stenting is in many cases the equal if not superior treatment. (A quick aside -- you mentioned that 11 years ago you had an aortic aneurysm treated not by surgery, but with a stent. If you look on the panel of the CRT 2008 meeting that Prof. Sievert is moderating, you'll see the name of Dr. Juan Parodi -- he invented the aortic aneurysm stent!)

Charles' story is a very important one to all posters -- get a second opinion from an experienced expert. If you're told by a surgeon that you cannot be operated on, find an interventionalist for a second opinion. And vice-versa! There are different ways to accomplish the same treatment, but they are not necessarily practiced by the same physicians.

To Roseanna and David C., to determine a course of treatment for your fathers, do as we've suggested above. Every patient's clinical situation is different. There are a number of factors that may make one treatment a better choice than another. It's a bit confusing to patients because it would seem that a vascular doctor would take care of carotids and a cardiologist would work only in the heart. But today's interventional cardiologist can delivery therapy throughout the body: the heart, kidneys, legs, carotids, aorta, anywhere he/she can reach with a catheter using the body's network of "arterial highways". Some vascular surgeons also do interventional work (like stenting) -- but not all. Do as Charles in Germany did -- try to find an experienced expert in the field and get an opinion.
Angioplasty.Org Staff, Angioplasty.Org, February 9, 2008

• Referring to your posting of December 4 , I since then found a Carotid Artery specialist in Frankfurt Germany. He successfully reamed-out my carotid artery and inserted a stent. The procedure lasted about one hour, painless and so far no complications other than a few post-operative minor aches that for the most have disappeared. This was done two weeks ago at the Katrina Hospital in Frankfurt by Prof. Sievert...... I have a date for a ultra sound check-up in another two weeks.
Charles Kevlin, Kronberg, Hessen, Germany, February 9, 2008

• My father is 75 years old. My dad has had one triple bypass in 1994 and another in 1998. He also has 100% blockage in the right carotid and 75% in the left. He is scheduled for surgery for the 75% blockage. It has me scared as I'm concerned about the risks and recovery. He has also had veins removed from his legs, I believe for one of the bypasses, maybe? Thank you.
David C., South Carolina, USA, January 25, 2008

• My post is mainly in response to Steven J. in Florida. I just wanted to share a positive story: I just went with my mother to see her vascular surgeon. She too felt like a ticking time bomb because one of her carotids had suddenly blocked 100%. Her other artery is 60% blocked. (Read my earlier post). When we spoke to her doctor, he explained that she only had a 1% chance of a stroke even with 1 artery - partially blocked! The vessels to the brain compensate, and the main issue is the velocity of the blood flow to your brain, not how it is getting there. Apparently a low velocity blood flow is good - sort of like a thumb over a garden hose. The more closed off, the higher the velocity. She gets this checked every 6 months even though they recommend every year. My mother's doctors seem to think she has a 99% shot at living a full life.
Sharon, Fallston, Maryland, USA, January 23, 2008

• My father had a massive stroke 2 years ago and was left with his left side paralyzed..He has been going to vascular doctor every three months. He has right side carotid 99% blocked and left side carotid 75% blocked (which increased 6% since August). His cardiologist tested him with a CT Angiogram and said his left artery in his heart has a blockage and he wanted to perform an angioplasty. My question is, is this safe and does Vascular Dr. take care of carotids and cardiologist take care of the heart when it comes to stenting? What happens if I do nothing. I am afraid it will kill him. Can both procedures be done at once? Please email me any information I can read on this subject. He has high blood pressure and high cholesterol which is being controlled with medication. Thank you.
Roseanna, Brooklyn, New York, USA, January 4, 2008

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