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Carotid Artery Stenting (CAS) -- 2007 and Earlier

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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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Archived Postings from 2007 and Earlier on This Page (113):

• Norma and Charles, and other readers who have been told they are not good candidates for surgically opening up their carotid artery -- there is an alternative: Carotid Stenting. It is less invasive and doesn't require general anesthesia and, in the right hands and for the right patients, it can provide an alternative. This may be a bit confusing because carotid stenting is done by several different types of medical specialists: interventional cardiologists, interventional radiologists and vascular surgeons. The trick is to find someone who is very experienced and comfortable with the procedure, and then have that physician evaluate your situation. You may not be a good candidate, but if you are, it is possible that other specialists are just not aware that carotid stenting can offer an alternative. In the right hands, carotid stents are the equal of the surgical procedure. But again, this is not medical advice to anyone in particular. Just a suggestion that you find someone who does carotid stenting and get a second opinion.
Angioplasty.Org Staff, Angioplasty.Org, December 4, 2007

• my husband has recently had open heart surgery, triple heart bypass and an aortic aneurysm and he had a stroke 14 years ago which left him partially blind in his left eye and another stroke several years later which left him unable to feel the ends of his fingers in his right hand. recently he suffered a T.I.A investigations have revealed one fully blocked artery and one 50-79% blocked the specialist has discharged him saying that it would be too dangerous to refer him to a vascular surgeon as operating would be too dangerous. we have also asked his cardiologist his opinion he says he doesn't want to comment as it is not his specialized field who should i see for another opinion?
Norma, retired, Barnsley, UK, December 3, 2007

• my age is 82. stopped smoking at age 41. started running at age 44. ran several hundred long distance races including 16 marathons. Continued distance racing until age 75. at age 71 a stent was placed in my aorta and since then the aneurysm disappeared or receded. an aspirin a day is the only medication taken. when the stent was placed in the aorta, a connecting stent was placed in my left leg artery... this procedure caused my left leg artery to get 100% clogged just below the knee. at age 75 I stopped running but continued walking 1 or more hours daily thus maintaining peripheral circulation in the leg. now I have been diagnosed with three coronary clogged arteries. the cardiologist refused to dilate the arteries during a catheterization test. he suggested a by-pass. an MRI test revealed that I have the right carotid artery clogged to approx 90% left carotid is less than 50% clogged and has good blood flow. by pass surgeons will not operate unless the carotid s are free..... a carotid surgeon doesn't want to risk an operation because of the coronary problem....... what are my options? I live in Germany....
Charles Kevlin, Kronberg, Germany, December 2, 2007

• S.M. -- we can't really dispense medical advice to you, but 100% blockages in the carotid are difficult to deal with because opening up a blockage results in a dislodging of plaque, which can quickly travel up the artery to the brain causing serious injury, stroke, even death. Many times the body may deal with a total blockage, which comes on over time, by creating collateral blood vessels which, while not as large as a normal artery, still allow some blood flow. The other question, one which a CT or MRI can answer, is what is the state of his brain tissue. The stroke may have already caused irreversible damage to parts of the brain, so opening up the blood flow may not result in much improvement. These are complex and difficult questions that should be answered by your father's physician. See our previous posts regarding second opinions.
Angioplasty.Org Staff, Angioplasty.Org, November 15, 2007

• My father (59 yrs, 5'9", 160 lbs) recently suffered a severe stroke in May 2007. Symptoms were loss of speech, loss of cognitive thinking and weakness. After going through many tests, we found both of his carotid arteries were 100% occluded. Are there any surgeries or procedures that he is a candidate for? Can anything be done once the carotid is 100% occluded? Please respond.
S.M., Missouri, USA, November 13, 2007

• Nancy -- any surgery, especially on the elderly, is a judgement call by the physician and depends greatly on each individual's specific case and clinical situation. If you have questions, you might want to get a second opinion. We, and many physicians, recommend getting that second opinion from a physician in a comparable but different specialty. For example, if you got an opinion from a vascular surgeon, try getting the second from an interventional cardiologist who is experienced in carotid stenting. And vice-versa. If both agree, then you can be pretty sure you're doing the right thing.
Angioplasty.Org Staff, Angioplasty.Org, November 13, 2007

• My 81 yr old mother who has dementia has 100% blockage in left carotid artery and 70% blockage in right carotid artery. Results were from her MRA that were read to me by her Vascular Surgeon. He put her on PLAVIX and said to have her walk more and watch her diet. How come no surgery is needed? I am confused. Thanks
Nancy GM, Cape Cod, Massachusetts, USA, November 9, 2007

• My mom is 71 and weighs 90lbs, has high cholesterol and a partial blockage of the artery on the right side of the neck causing her to have very bad pains on the right side and top of her head. What treatment if any would you suggest?
Jeanette, Bermuda, September 30, 2007

• I am a 55 year old male who had a small heart attack in May and was recently sent for Ultrasound on my carotid arteries, despite being asymptomatic. To my amazement, one artery was said to be totally blocked and one artery was said to be normal. I am awaiting results from my CT Angiogram to see if it confirms the Ultrasound. My question is whether you think I would have a better prognosis if my artery was totally blocked (since collateral blood vessels must be keeping me asymptomatic) or whether you think it would be better if my artery was 80-99% occluded (and a blood clot would have space to form) In each scenario, what do you think my chances of getting a stroke are in the next 10 years? (assume I will take all my heart medicines and will consent to surgery if my artery is not fully blocked.) Thank you.
L.P., New Jersey, USA, September 27, 2007

• I'M 32 YEARS OLD AND HAD A STROKE DO TO A DISSECTION IN MY INNER CAROTID ARTERY. I'M ONLY LIVING WITH ONE CAROTID NOW! MY QUESTION IS WHAT WOULD BE MY RESTRICTIONS OF LIFE... I GET GET DIZZY WHEN I WALK, DOCTORS STATE NOT TO GET STRESSED OR IRRITABLE, YET LOOK AT THE WORLD WE LIVE IN. CAN I EVER LIFT WEIGHTS AGAIN...I'VE LOST 35 LBS SINCE THIS INCIDENT. THANK GOD I'M NOT IMPAIRED, YET I FEEL ROBBED FROM THINGS I DID AND FELT...I'M A DIFFERENT PERSON...I'M SCARED SOMETHING WILL HAPPEN TO THE LEFT CAROTID AND THATS MY LIFE.
Steven J., Florida, USA, September 14, 2007

• To all who write in asking advice -- we cannot give specific medical advice to anyone, but if you have questions you should ask your specialist. Carotid artery disease is currently being treated in three ways. Medication and life style change alone or, if there is a significant blockage, either open surgery or a stent. Each has advatages, depending on the specific situation of the patient. For example, a patient who may not do well with a major "open" operation may be better treated via stenting, which is done with a catheter through the artery in the leg/groin area. There are several medical specialities practicing in these areas: interventional cardiology and radiology, as well as vascular surgery. We, along with most physicians, would recommend getting a second opinion in cases where you have questions. We would further suggest that you consult with a physician in a different specialty from your first opinion. For example, if a surgeon gives you an opinion, try getting a second from an interventional cardiologist -- and vice-versa.
Angioplasty.Org Staff, Angioplasty.Org, September 1, 2007

• My husband is experiencing ringing in his ears,severe headaches, dizziness, and he has very bad sleep apnea. Is this a sign of carotid arteries? He has a family history of: Father died of heart attack at 46 years and his mother had narrowing of the arteries,Parkinson's. She died at 87 yrs. Grandparents stroke.
Sandy G., Mississippi, USA, August 25, 2007

• My Friend is 69 years old but has always appeared and acted much younger. For several months she has been experiencing several TIA and recently had testing done for carotid artery blockage. She has blockage in her neck and all the way to her skull. Her first Radiologist stated she was not a candidate for any operation for stent due to her condition and that there was too high a risk of her not surviving the procedure.What can be done to help her condition can you tell me about this.Thank you.
QM, New York, USA, August 21, 2007

• I am a 58 year old otherwise healthy woman. Just confirmed 100% blockage in my left artery. Other carotid and arteries are widely patent. I was told an operation can't be done w/100% blockage and just to watch that my other arteries keep flowing by doing a yearly ultrasound, eating right and exercising. However, my doc told me that I am working on "4 cylinders instead of 6". I bluntly asked what this means to my lifespan, but he laughed this off. Please let me know had badly this 100% blockage will affect me. Thanks.
Barbara, Florida, USA, August 17, 2007

• My mother is under the care of a team of vascular surgeons. They never quite explained to her why her artery clogged so fast, except they did tell her that she had arteries similar to a cow's?!? Does that make sense to you? She had an angiogram to confirm the occlusion and goes for regular (what I call) sonograms every 6 months. I believe the doctors had decided not to operate until the blockage in the left artery worsens. However, since the right artery clogged so fast, she is afraid the left could do the same. I think she needs antidepressants or the stress is going to take it's toll. That's why I'm looking for some good news to pass along. Have there been any advances in your field concerning carotid bypass? What is the success rate of surgery/stent and how long do they last?
Sharon, Baltimore, Maryland, USA, August 7, 2007

• my husband of two years went in for routine physical was found to have the right and left side carotid artery block. Left side was shown with a doppler to be 80 % - 40 min into recovery he suffer a mass stroke leaving him with left sided paralysis, left side deglet , not able to move his left arm at all can walk approx 20 feet. they only did a Doppler on him before surgery. it took them 4 hours to get him back into surgery to repair the clot. by that time the damage had been done. today i get news that the angiogram that was done is showing that the right carotid that they repair, has now close off completely and his left side is greater than 75% they are now talking about doing a by pass on his carotid artery. i need more information on the procedure. please can you help us?
Connie J., California, USA, August 6, 2007

• Sharon -- we would ask what imaging tests were done to determine that it's a 100% blockage? We assume an MRA, CTA or standard invasive angiogram were done. Seems like the occlusion occurred very quickly. Has she been evaluated by a vascular surgeon and/or an interventional cardiologist or radiologist? They would be the best source of a prognosis, sonce they also have information on your mother's total clinical picture. Certainly discuss with them options for keeping the left carotid open (either surgery or stent) and how often she needs to get tested.
Angioplasty.Org Staff, Angioplasty.Org, August 6, 2007

• My mother has been diagnosed with an inoperable 100% blockage of her right carotid artery (like many of the other people posting). She had no symptoms, it was discovered by hearing a bruit early when her artery was about 50% clogged. Within a year when she was went for her follow up exam, the artery had completely occluded. Her left artery is about 40% clogged. She is taking Coumadin and aspirin. My question is what is the prognosis for someone living with one artery? Are there studies? My mother is sinking into depression because she feels like a ticking time bomb. Is there some positive information that you can give me to pass along to my mother about people living with one artery? My mother is 65...is it possible that she could live until she's 95?
Sharon, Baltimore, Maryland, USA, August 6, 2007

• There is a non-invasive alternative to the carotid artery stenting procedure. It should be considered in those instances where the patient has also been diagnosed with Class III or IV angina associated with ischemic heart disease and therefore would be reimbursed by Medicare or CMS. It is well established as a safe and effective procedure for improviong circulation which then relieves the symptoms of angina. Now, a new study from Europe shows clear and unique patient benefits for carotid artery circulation with this procedure (Enhanced External Counterpulsation or EECP) that would not be possible with carotid artery bare metal or DES stenting
Gerald Oros, Collinsville, Ilinois, USA, May 27, 2007

• Barbara -- has your mother been examined by a vascular surgeon, or interventional cardiologist/radiologist, or a neurologist? These are all specialists who do carotid surgery and/or stenting. These sound like symptoms that might be due to TIAs (small strokes) and although 60% is not that large, it's the functional measurement (actual blood flow) that's important, not just the amount of closure. There are other tests like angiograms (CT and standard) and fractional flow reserve that might yield more info, although some are a bit more invasive.
Angioplasty.Org Staff, Angioplasty.Org, May 14, 2007

• My mother had three way heart bypass surgery in October 2006 after undergoing a cardiac cath. She is 55, never drank or smoked, and is very petite. Approximately 6 weeks ago, she lost her vision in her right eye. Her eye doctor sent her for doppler studies of her carotid arteries, at which she is 60% blocked. It has still not been determined what made her lose her sight overnight, or if she will get it back. She also is experiencing dizziness and falling when in confined places such as hallways. She is currently on Plavix, Atenolol, HCTZ, and an aspirin. Could the 60% blockage be causing her problems? Thanks so much.
Barbara, North Carolina, USA, May 7, 2007

• Pat -- you write that your father had "surgery" -- did he have the open surgical procedure called endarterectomy? Or was it a carotid stent -- which is an angioplasty and is not considered surgery. Stents are deployed along with an umbrella-like device called an embolic protection filter, specifically designed to trap piece of plaque, called emboli, from traveling to the brain.
Angioplasty.Org Staff, Angioplasty.Org, May 3, 2007

• My 75 year old father has been experiencing moderate to severe headaches continually for the past four weeks. Testing revealed approx. 90% blockage in the right carotid artery. He underwent surgery 4 days ago to remove the blockage but the headaches have continued, just as severe. Apparently he had 3 or 4 TIAs prior to the surgery and had pieces of plaque travel to he brain. What will happen to the plaque in his brain and should the headaches go away? He was told to "just give it some time". We are very concerned the headaches have not subsided, is it likely there is another cause of the pain? Thank you, your opinion is greatly appreciated.
Pat M., New York, USA, May 3, 2007

• Judi -- you've written before about the wide variation in interpretation of your tests. We're not sure what type of specialist did your previous imaging tests, but carotid artery disease has long been the specialty of vascular surgeons, and in some centers increasingly, interventional cardiologists and/or radiologists. Blocked carotids can be opened up, if they are severe enough (and so far yours do not seem to fit this category) either through open surgery or less invasively using catheter-based stents. Hopefully the vascular surgeon will be able to give you more specific and accurate measures of what, if any, problems you have. Let us know how things go.
Angioplasty.Org Staff, Angioplasty.Org, April 28, 2007

• I have been referred to a vascular surgeon and he said my tests showed 60% in right and did not address the left carotid artery. Has scheduled another Ultrasound for July, 2007. Will I have to have another CT scan and arteriogram if it has increased this time? I am getting tired of all these tests not to mention the expense.
Judi, Tennessee, USA, April 26, 2007

• I have a blockage in my left carotid artery that shows between 50-69% but no plaque build-up and no stenosis. I'm not sure what makes this different in being treated compared to those treated with plaque build-up. I also have slowing of the peroneal nerve in the lower extremities. The research I've done, I'm still not sure what this means. Everything I've seen either refers to the peripheral nerve or eventual paralysis. I've only been able to talk to the nurse since all my test results have come in and don't have a follow-up appt. until May. The nurse says that my fibromyalgia may make all this difficult to treat, plus the fact that I already take 15 different meds., I may not even be able to be on a blood thinner regime. What is the difference in no plaque build-up and build-up are? I've read that stenosis is heart disease and not have it is to my benefit. Is there a way to explain slowing of the peroneal nerve in layman's terms?
Vickie, Birmingham, Alabama, USA, March 27, 2007

• P.W. -- A cardiologist might prescribe medical management, or might discuss stenting. There's been a lot of news about carotid stenting recently, with several new product approvals and with Medicare now proposing to expand coverage. But a 65% blockage in an asymptomatic patient is 15% below even the expanded coverage proposal (and most insurance carriers use Medicare as a guide). So, according to Medicare, your blockage is not significant enough to be covered. A 65% blockage may sound significant, but the carotid arteries are quite wide (much wider than coronary arteries) so the blood flow to your brain may not in fact be reduced. But your doctor is the best judge of these things. Let us know how your appointment turns out.
Angioplasty.Org Staff, Angioplasty.Org, February 19, 2007

• I am a 56 year old male. Just had an IV Contrast enhanced CT angiography of the carotids performed. They found a 2-cm long area of stenosis equal to a maximum of 65% involving the left subclavian artery, just distal to the origin, proximal to the takeoff of the left vertebral artery. Every thing else was Patent. It is from what I understand soft plaque. I take an aspirin a day and am on diovan hct32mg/12.5 mg for high blood pressure. Went in for the test because my doctor heard a bruit. With all that said, I feel great -- now I need to see a Cardiologist, what's next? what should I expect?
P.W., Illinois, USA, February 13, 2007

• I am a 50 yr old female with Takayasu's Arteritis vascular disease, I have been having symptoms of syncope and other weird symptoms, a strange feeling of passing out or dying, this frightens me very much. Both carotids are 95% or more blocked now I have to see a surgeon in Toronto, and I am scared to death of having surgery. I have 3 coronary arteries involved, left kidney artery is also compromised and the aorta itself is narrowed, I have high BP 220/70 in the legs no arm pulses because my subclavians are 100% occluded, I need to see an expert where would I find one who would take a chance on someone like me?
Louise Hobbs, Brampton, Ontario, Canada, February 10, 2007

• First of all, to recent posters. You have heard this before, and we know it is hard -- but you must stop smoking! Smoking is the number one risk factor for vascular disease: heart, carotid, legs, you name it. Smoking just messes up your arteries. And we realize it is hard to stop, but you need to make an effort. As for percentages of blockages, and MRA and CT scans -- the accepted standard for imaging carotid stenosis (blockage) is a duplex ultrasound. And it needs to be done by a certified lab. You don't just want to see the blockage -- you want to see above it so you can see what the carotid artery looks like where there is no blockage. You may find that the blockage is not as severe as you thought.
Angioplasty.Org Staff, Angioplasty.Org, January 26, 2007

• I am 61 years old I have been told that I have 60% blockage in the left carotid but less than 15% in the right. I have always had high cholesterol and I smoke. Do I need surgery for this.
Judy B., Florida, USA, January 26, 2007

• My mom is 73yo and had a stroke 4 1/2 years ago. I came to her house while the stroke was in progress. For the first 3 days after her stroke her speech was slurred, but she could use her left hand/arm. On the 4th day her speech cleared up perfectly but she lost the use of her left hand/arm. Her left carotid was 40% blocked and she had 100% blockage of her right carotid which meant she was not a candidate for surgery. After a year of rehab she can use her left leg, with the use of a foot-to-hip brace. However, she has drop-foot with left leg weakness. Her left arm/hand has never regained any function. She still lives on her own. She can cook, do some of her cleaning, make her bed, dress on her own to a great degree, and is still basically independent. It has not been easy (on her, or those of us who love her) but it can be done. She was not what the medical community would consider a stroke candidate: she was not over weight, did not take ANY medications, she did not have high blood pressure (even when she was having her stroke her BP was normal), she did not have high cholesterol, she didn't smoke, she worked part-time, and was very active. These past 2 weeks she has been experiencing TIA's. She was hospitalized for 4 days last week and went to her cardiologist today. We were told that the last carotid duplex she had a little over a month ago showed that her right carotid is now showing 60-70% blockage (from the 100% blockage she has had for over 4 yrs). He is going to do another carotid duplex on Monday and said that if the blockage has decreased it might mean that there are clots being thrown off as flow is being restored, and it is these clots that may be causing her recent TIA's. If so, he said she would now be a candidate for surgery. I guess by writing this I am wanting to let others know that things can change when you least expect them. Have faith, show love, be patient, do what you can when you can, and be aware! My prayers and thoughts are with you all.
Gail B., Missouri, USA, January 25, 2007

• My father has had kidney disease since he was 24 and was on dialysis for about 23 years until he finally got a transplant. Recently they have found possible calcification in his carotid artery. Initially he had a CT scan that showed it was about 79% calcified and they were going to operate. But before they did they had him do a MRA and found out it was only 10% and are not worried. Is this normal for such a big difference to occur?? Or should he have another doctor give him a second opinion with another test??
C.L., Murrieta, California, USA, January 24, 2007

• my husband is 62 yrs old has blockage on both sides 60 to 70% and smokes, he does get dizzy, is it time to have surgery? a very worried wife (he is still working)
Maggie, January 24, 2007

• Jan -- we don't offer medical advice which is something that can be done only by a doctor who can examine and see the patient's records, if not the patient himself. Maybe some other readers have suggestions. The only advice we can give is to make sure you understand the specifics of why they can't do the AAA stent-graft, and what, if anything, can be done for the carotids. Being 90, your dad is somewhat compromised for an open surgical procedure. Have they mentioned carotid stenting? Also, a abdominal aortic aneurysm (AAA) is progressive. How critical it is depends on the side it's gotten to. Would you be able to get a second opinion? We don't recommend any hospital in particular, but The Ochsner Clinic in New Orleans has some of the most experienced interventional cardiologists and radiologists around (they hold a major course each spring). For more info on carotids, check out our interview with Ochsner's Dr. Christopher White. Let us know what you find out.

100% carotid blockage (a.k.a. "total occlusion") has shown less favorable outcomes, but techniques are being pioneered all the time. Again, you'd need to have someone very experienced in doing either surgery or stenting on totally occluding carotids -- and much also depends on the clinical situation of the patient and the other vessels.
Angioplasty.Org Staff, Angioplasty.Org, January 3, 2007

• My father is 90 years old. He was recently diagnosed with an abdominal aneurysm, while in the hospital for flu-like symptoms. He was sent home during the holidays and we were told to call after the new year to schedule surgery for the aneurysm (a stent). Today we were told its now not possible because my dad has 100% blockage in his carotid and 80% in the other. We feel totally helpless. There has to be something we can do. Any advice?
Jan, Metairie, Louisiana, USA, January 3, 2007

• My husband has 4 stents in his legs,has had a CABB 4yrs ago and now has been told his carotids arteries have 90% blockage on his left internal and 60-70% on his right common artery. The right also has irregular homogeneous plague. He is only 62 and suffers from diabetes. Does surgery sound like a good solution? His only symptoms are dizziness.
A., Chicago, Illinois, USA, December 28, 2006

• can any surgical procedures be performed on a 100% carotid blockage situation?
Betsy Rettew, Pennsylvania, USA, December 25, 2006

• Marie, and others who are worried about the news over the past few months about carotid stenting being "dangerous" -- first off, no procedure is perfect. And one may be better for one person; another for a different person depending on many factors: general health, age, status of arteries, etc. I can tell you that there is much controversy among doctors in the U.S. over the relatively inferior results that were seen in two very small European studies of carotid stenting, mainly that they didn't use "embolic protection devices" (filters that screen out clots and emboli that can travel to the brain and cause stroke) and that a number of the operators had only done a few procedures (like all medical procedures, the more a physician has done, the better his results). The major trial comparing carotid surgery vs. stenting is still recruiting' it's called the CREST trial and it is tightly controlled, with everyone using the same device in similar cases. Results won't be available for some time.

As for the drug-coated stent problems, carotid stents are NOT drug-eluting stents. They are bare-metal, because the carotid arteries are very large and restenosis is not a big problem-- no reason to use drug-eluting stents. The challenge in carotid stenting is to place the stent, using the filter, so as to avoid stroke -- you're 9 months out and seem to have had very positive results. We would not worry.
Angioplasty.Org Staff, Angioplasty.Org, December 23, 2006

• four years ago i had quadruple bypass at the age of 43. at that time the dr's also found my left carotid artery to be 80% blocked. No surgery was done on the carotid at that time and the blockage reduced after the bypass surgery to 49%. Fast track 4 years later blockage found to be 80% again. I had a stent implanted 9 months ago. after all the recent media attention on the new risks found on the drug coated stents...I am very upset. I am unsure that I made the right decision.
Marie, New York, USA, December 11, 2006

• I just got in from the hospital. My mother had a carotid artery endarterectomy Thursday evening & suffered complications, is in ICU, even the neurologist is baffled because her left-side weaknesses (right artery operated on) seem to change. I'm alarmed, however, as by the time ICU visits were closing, she couldn't grip at all with her left hand. She has apparently suffered 2-3 strokes although we've been told there was no abnormal brain activity during the procedure. The artery is now 100% clotted. What can we reasonably expect in terms of recovery?
B. W., Arkansas, USA, November 18, 2006

• Quest: is 100% stenosis any poss for stenting with protection? If so, what type of dr/hospital to start checking. with a 100% blockage and a 40% blockage as shown on angioplasty and associated TIAs, Drs are telling my father inoperable because of the 100% has clots formed below the 100% blockage, that they will release if try anything and cause stroke. He does not have an aneurysm or Seeing in many studies that protection (filter/balloon/etc) would take care of the clots but can't find actual reference that it is being done on 100% that haven't had full stroke just on tias. Many of the studies seem to just perform procedures on less than 100% stenosis. 1) Where do I need to look/or who to ask to find out if stenting is even a possible course of treatment in case of 100%? 2) does the clotting have anything to do with anything 3) is there less reason to treat for 100% than for 98% - i.e. is he actually in ok shape on the one that is completely blocked? 4) is there someplace that a layman can access the global registry of carotid artery stenting?
Concerned Daughter Betsy confused by the research, Pennsylvania, USA, November 18, 2006

• My mother had had a minor stroke due to that her right carotid artery is 100% blocked. Luckily her left carotid artery is 100 % clear. She can't talk and can't move her right arm and foot. I was so devastated. I would appreciate if somebody can tell me if my Mom has a chance of walking again. Thank you so much.
Alfredo, Philippines, November 10, 2006

• Judi -- angiography (a.k.a. arteriography) is considered the gold standard and the most accurate measure of a blockage. Multislice CT scanning is definitely close, and some think better, because of the three-dimensional image produced.
Angioplasty.Org Staff, Angioplasty.Org, November 5, 2006

• For 4 years I have been having ultrasound for right and left carotid artery blockage. I had an arteriogram in April, 2006 which found only 30% blockage on the right. Just had another ultrasound which showed 50 right, 60 left arteries. so I have been scheduled for another ultrasound or ct scan in 6 months. Why are all my tests showing such a difference in conclusions. I hear bruits at night before going to bed, early morning when I arise, etc.
Judi, Tennessee, USA, November 3, 2006

• My husband had a major stroke in June of this year due to both carotid arteries being 100 percent blocked. He's a walking miracle because when the stroke took place, two arteries (small) opened in the back of the brain. All of the doctors that we have seen said to us that he should be dead. He has weakness on the left side of body and some memory loss and sometimes can't remember short term either. They cannot due surgery for his arteries but thank God he has the two openings in the back of the brain. I have sixty percent blockage in both carotid arteries but the doctor said I was okay for now unless they get worse. So far all of you out there that are worried about a 50 percent blockage, I would consult with my vascular surgeon. God Bless All Of YOU!!!!!!!!! By the way, the vascular doc. said that radiation probably caused my husbands blockage. He had radiation 10 yrs. prior to his stroke. 29 radiation treatments. They were very intense treatments for throat cancer. He is now a laryngectomee. He had 2 mini strokes 4 years ago also. At that time we thought he just had Vertigo because the symptoms were, dizziness, upset stomach, etc. We were just not thinking of strokes. Ringing in the ears, headaches, dizziness are very good signs of blocked arteries. I would definately have them checked if you have any of those symptoms.
Betty Gleason, Missouri, USA, October 13, 2006

• Julie -- a 40% blockage in an artery as wide as the carotid is most likely not causing a reduction in blood flow. That and the fact that your dad has developed what are called "collaterals" on the other side are probably what informs your doctor's decision to stay with medical management. If there's no reduction in oxygen delivery, then there's no reason to intervene. Surgery OR angioplasty on the carotids carries with it a risk of stroke, etc. -- not recommended unless the risk of doing nothing outweighs the risks of the intervention. Your doctor's conservative approach seems correct, but certainly get a second opinion, just to set your mind at rest. Perhaps if you saw a vascular surgeon, try talking to an interventional cardiologist, or vice-versa. Just to get a different point of view. You're right that the disease process is all related. Knowing that he is in risk category, the best thing to do is to reduce any risk factors (diet, smoking, etc.) and keep an eye on things. Controlling high blood pressure is very important, and he's doing that. Someday there will be that magic pill to dissolve all the plaque, but until then negative tests are a good sign!
Angioplasty.Org Staff, Angioplasty.Org, September 17, 2006

• Please help. My father, age 69, was just diagnosed with a 100% blockage in his right carotid artery. The ultra sound indicated the blood flow had rerouted itself using other smaller arteries. His left carotid artery has about 40% blockage. His family physician sent him to a vascular surgeon. He ordered a CAT scan to see if he had had a stroke. The test came out negative. He recommended that my dad just go home and live his life with no restrictions. However, my dad had four coronary stents put in a couple of years ago. He has high blood pressure that is controlled with medication and he is borderline diabetic (just controls diet, no medication taken. He is very active. He is the family handyman doing construction work, mowing, etc. I know that all of this blockage is related to one another. It is just very hard for me to believe that nothing can be done in the year 2006 with all of our technology. Please try to get back to me asap. I am praying for an some sort of answer.
Julie Watson, Leadwood, Missouri, USA, September 17, 2006

• I have been told by my cardiologist that I have a 100% blockage in my right artery and a 50% blockage in my left. He says the 100% blocked artery is inoperable. I had a muscle biopsy and it shows that I cannot take the cholesterol medicine due to it is destroying my muscles. I have eat healthy and been active all my life, I am not overweight. The doctor says this is genetic. What will happen and what can I do to prevent a heart attack.
S., Virginia, USA, August 19, 2006

• C. -- if your doctor has determined that more needs to be done that medical management (drug therapy) -- then there are two options: open surgery, called a "carotid endarterectomy" where a vascular surgeon opens the artery and physically "scrapes out" the plaque. This has been the standard for many years and is one of the most often performed vascular procedures. More recently, angioplasty and stenting has been used in some cases. Just as in coronary (heart) angioplasty, a balloon with a stent is inserted into an artery in the groin, threaded up into the carotid, inflated (which opens the artery by compressing the plaque build-up) and then deflated and removed, leaving a metallic mesh (stent) behind to keep the artery opened. A small filter prevents small particles (emboli) from being transported up into the brain, which could cause a stroke. Your doctor (cardiologist, interventional radiologist or vascular surgeon -- they all perform carotid stenting) can tell you if you are a candidate for one or the other or both.
Angioplasty.Org Staff, Angioplasty.Org, July 18, 2006

• I had radiation to my neck years ago. I now have carotid artery stenosis. What procedure is needed to clean out the carotids?
C., Kentucky, USA, July 18, 2006

• My mother had a 99% block in left artery and 80% block in right artery. The cardiologist wanted to do angioplasty. While doing it she died. Doctor's conclusion was it is due to cardiorespiratory failure. What's that mean?
Indika, Sri Lanka, July 3, 2006

• I had artery surgery in 2004 and it blocked up with scar tissue. I had a stent in April of 2006. I have had two episodes of the neck not feeling right. It feels like the neck is tight and something large in the neck. It hurts and the pain went to my jaw and ear. When I swallowed my throat was sore on that side. What could have gone wrong?
Wanda Goldwater, Wichita, Kansas, USA, July 2, 2006

• My dad suffered 1st tia 3 years ago. Last week had 3. Was told to have surgery based on CT scan. Later told MRI showed 100% blockage in carotid artery. Was told cannot do anything about it. Not to worry, other side is only 50% blocked. Is this true. Can We do anything? It seems like we sit and wait for the "big" one!
T.D., New York, USA, June 24, 2006

• My left Carotid Artery is 100% blocked & my right Carotid Artery is 50% blocked. Is there any thing that should or can be done?
O. I., Washington State, USA, June 21, 2006

• Mary, you say "surgery" -- was it "open surgery" where the neck is actually opened and the artery cleaned out (called "endartarectomy") or was a carotid stent used, inserted through a small incision in the femoral (groin) artery and done while the patient is awake?
Angioplasty.Org Staff, Angioplasty.Org, June 2, 2006

• I have had surgery on my left carotid artery which was 85 to 90% clogged but my right carotid artery is 100% clogged, so my question is why didn't they do surgery on my right artery, I don't understand -- please give your thoughts on this.
Mary, Licking, Missouri, USA, May 30, 2006

• Is there any new research to address if there's anything more that can be done for people that have been diagnosed by a MRA with a 100% occlusion or blockage in one of their carotid arteries? My dad was told that the results of his MRA was that he was 100% blocked on one side and he was told that the other side was "pretty much open" [no % given!]. Many thanks for your help.
AK, McLean, Virginia, USA, May 28, 2006

• Diane -- the Medicare coverage for carotid stenting was last expanded in March 2005, although advocacy groups have been pressing the agency to broaden it, and this is currently being considered. CMS's current policy reimburses for symptomatic patients with blockages between 50-70% and asymptomatic patients with blockages of 80% or more. All patients currently must be considered "high-risk" for the corresponding open surgical procedure, called endartarectomy. Since your husband has had previous endartarectomies, he would be considered in the high-risk category. If he is has no symptoms, then he seems to fall just short of the Medicare criteria -- but perhaps more followup and precise imaging might measure the blockage differently. Of course, he can still have the procedure, but it might not be covered. As Dr. White states in his interview, it's not a bad idea to get a couple of opinions. This field is changing rapidly -- some vascular surgeons do "endovascular" procedures, like carotid stenting, and some don't. Many interventional cardiologists and radiologists also do carotid stenting. Sometimes these specialties compete with each other for patients. Sometimes they work together in a cross-discliplinary approach (many "Heart and Vascular Centers" are currently being formed to meet this need). What you want is an opinion from someone who does these procedures regularly and is confident in saying whether now is the right time. As with all procedures, surgical and interventional, there is always a risk, and this risk has to be weighed against the benefit. Current figures show the risk of a major complication for either of these procedures to be pretty similar. Good luck and let us know how you fare.
Angioplasty.Org Staff, Angioplasty.Org, April 26, 2006

• My husband had carotid surgery on both sides in 2002. He is 69 years old now. Both sides have developed restenosis. The right side is about 50% blocked, but the left side (after a MRA) is 69 - 75% blocked. He hasn't had any symptoms. He has seen a neurologist and has been referred to a vascular surgeon. Is a stent the next step? We understand the complications that could occur with another surgery and want to avoid this. His mother died from a severe stroke, so we want to be proactive in taking care of anything that might lead to a stroke. He is anxious to get the stenting procedure since he can hear his bruit every night as he tries to get to sleep. Any advice or information you can provide would be helpful.
Diane J., Arkansas, USA, April 26, 2006

• Janet -- carotid stenting has been approved for certain patients by the FDA. There are two devices currently approved for use in the U.S. -- the Acculink/Accunet system made by Guidant was approved in August 2004 -- and the Xact/Emboshield system made by Abbott was approved in September 2005. Read our exclusive interview with Dr. Christopher White about carotid stenting. In that interview, Dr. White specifies who Medicare currently reimburses for: patients with "more than a 70% diameter stenosis of the carotid artery, in a symptomatic patient, meaning either a transient ischemic attack, a TIA or stroke, AND the patient has to be at high risk for conventional therapies or high risk for surgery." Your husband seems to fit the first criteria. The question would be, is he "high risk" for open surgery, called endartarectomy? And if he isn't, why isn't open surgery being recommended? (Remember, carotid stenting and angioplasty is not technically "surgery".) Additionally, there have been several clinical trials that show increased benefit of carotid stenting for even asymptomatic patients, but FDA approval and Medicare reimbursement in those cases awaits further testing and trial results to prove that it is superior to surgery. Unfortunately, if you search the internet for "carotid stenting", you'll find a lot of outdated information that still refers to the procedure as "experimental" or "investigational". It is no longer experimental, and it is being done every day in major centers by major physicians (Dr. White, for example, is one of the most highly regarded cardiologists in the U.S. and is a member of the FDA advisory panel for medical devices.)
Angioplasty.Org Staff, Angioplasty.Org, April 22, 2006

• my husband had a stroke 10/23/05--has had major set backs--bouts with anemia--iron depletion--10 units of blood in the month of march. Right carotid is 99 % constricted--Left Carotid is 50% constricted. Having headaches, blurred vision, ringing in his ears--BCBS will not preauthorize the surgery (Carotid Stent Procedure (because they feel it is an elective and experimental surgery. My husband is a stroke waiting to happen--doesn't Medicare pay for these procedures--this is very important and very urgent--PLEASE HELP> in Norman oklahoma
Janet Somers, IBCI, Lindsay, OK 73052 USA, April 19, 2006

• My father is 85 years in excellent health.He has severe blockage in Right Carotid with syncopal episodes.Will carotid stent help? Who would be the best person in India to perform this procedure?
H.Reddy, New York, USA, April 11, 2006

• My mother was diagnosed with 'total blockage' in her right carotid artery. She is healthy bp 110/65 active, 120 pounds at 5'6'' and 71 years old. Shouldnt they operate to clear this? I keep reading they wont operate on 100% only up to 99% blocked. Every woman on her side of the family has had a stroke and she wants to avoid. She was having night sweats and tired so she went in to find out what was wrong. He ordered a scan and found out this.....we are so confused.
donna mays, chicago/illinois/usa, April 10, 2006

• Victor -- did the MRI or CT show any blockage in the carotid??
Angioplasty.Org Staff, Angioplasty.Org, April 7, 2006

• Hi, Im wondering if anyone here has had arterial blockage or some ind of artery disease which gaves them bad headaches, which may have worsened with certain medications. I have had a constant headache for the past 4-5 months mri and ct normal, A doctor from russia suggested I have my carotid artery checked. Im wondering if headache is possible from carotid artery blockage???
Victor, Silver Spring, Maryland, USA, April 5, 2006

• Diane, your doctor is correct. While a 50% blockage sounds like it should be fixed, most trials and studies show that the risks associated with ANY medicare intervention don't become worth it until you get to blockages of 70% or more. Medicare currently only reimburses carotid stenting for blockages greater than 70%. And indications for open surgery are similar. Not sure what the technician meant about blocked flow. Did you bring this up with your doctor?
Angioplasty.Org Staff, Angioplasty.Org, April 3, 2006

• To Colett in Nevada, it is very difficult to say how much a stroke victim can recover. We have seen significant advances -- physical and other types of therapy are critical. The patient's physicial condition prior to stroke is also important. Stroke recovery is beyond the subject of our web site, but there are many resources available. As for the other artery the doctors discussed, the human body has two of many things, and carotid arteries fall into that -- a left and right, each of which branch off into external and internal (Guidant has a good diagram of this.) We send our hopes to you for your husband's recovery.
Angioplasty.Org Staff, Angioplasty.Org, April 3, 2006

• my mother is 80 years old and has been diagnosed with 50% blockage in both carotid arteries. Also, a technician doing the test mentioned that the bloodflow to the back of the neck was completely blocked and the blood was having to draw from the right side. She has had severe dizziness and trouble walking for a month and we just knew this was the reason. Her doctor says that 75% blockage is considered severe and did not want to do any procedures at this time and says her dizziness is from inner ear. What should we do at this point?
Diane Fondren, LaGrange, GA, March 29, 2006

• Hello.. My father had a massive stroke on October 22, 2005 and has been in rehab ever since. He had a total blockage of his right carotid artery and was just tested the other day and his left carotid artery is 60% blocked. They have sent him for an MRA and we did not get the results yet. Has anyone else had this problem. I am concerned since he still is unable to walk and I don't want him to have another stroke after all the hard work he has done. Thank you.
Anonymous, March 28, 2006

• My husband has recently (in england) had cartotid stenting, he had one side done on a Tuesday, and the other side done the following tuesday, through the same artery in his leg. All went find until the following sunday when he starting getting shows of blood. Local hosptial said it was nothing to worry about, dressed it and told us to not take the dressing off or get it wet and get the district nurse to redress it the following thursday. During this time my husband day by day felt it getting more uncomfortable. Went to see the district nurse - who then sent us to the hospital and it was found he had an aneurysm. The consultant told us this is one of the risks of stenting. No - one told us of this risk, yes we heard he had a chance of having a stroke, or heart attack, but not about this. Patients and carers should be told of all the risks - this was life threating, and we did not know. Is it different in america?
Sylvia Hudson, England, March 22, 2006

• My husband had his left carotid artery ligagted after suffering a major stroke in Aug. 2005. It was explained to me that my husband had no chance at all and this was the only proceedure that they could even try. It was explained that his artery came apart. The Dr. said after the procedure that my husband had an extra artery running from one side of his brain to the other. He has minimal use of his right arm, hand and fingers. His right leg and foot remain weak. He has displasia and also cannot write what he is thinking. He understands what people say, his personality has not changed. He reads, and does some writing with his right hand using a pen or pencil, although it is difficult. He takes care of his personal needs. I am needed as an interpreter with doctors, investors, insurance companies, his law partners, family and church members, etc. He gardens, has an exercise routine at 24 Hour Fitness and walks three days a week. He can drive. He was 51 years old at the time of his stroke and in perfect health, swimming laps five days a week and playing tennis most Saturdays for most of the last 30 years. He had speech and occupational therapy in hospital rehab and outpatient rehab. Is there any chance that his language will ever come back? Will he ever be able to write his thoughts again?
Colett J., Nevada, USA, March 22, 2006

• My father has one carotid artery that is 100% blocked and the other is 50-79% blocked. He currently is asympomatic. A vascular neuroligst's opinion is to do nothing except watch the diet, take medication (ie.aspirin,Plavix, Lipitor, and B vitamins etc..) A cardiovasular Dr. said that we should get an angiogram done and possible stenting. We are confused about what to do? Could the angiogram cause a stroke? Any suggestions on how to proceed?
Deb, USA, February 25, 2006

• My husband had a stroke two years ago. At that time, he was diagnosed as having 100% occlusion of the right carotid and 50% in his left. Due to his condition, he was unable to continue work; his attention span was affected by the stoke. Therefore, we did not have insurance for quite a while. I was a public school teacher, and I felt I should resign b/c of the hours I worked: he needed my time more. I recently obtained new employment and now we have insurance. He had an ultrasound on his carotids a few days ago; now the tests say that he is not 100% occluded. They did not even mention the left carotid to him. He will have a CT scan next week to determine the exact percentage of occlusion. I have been searching the net for breakthroughs in this area. One, I saw that at Thousand Oaks Hospital in California, a new procedure using a device that protected one from possible stroke during stenting was used. Do you know anything about this? I want the best medical care for him. He is 56 years old, and until his stroke was extremely active. He is now exhausted most of the time. Please let me know the best way to go and please how to initiate this kind of care. They are talking surgery here. Isn't the less invasive better? As you can tell, I'm am clueless even though I've tried to keep informed. I usually just read from the net, and most of it is too complicated to interpret. In other words, what's best? what's good? etc. etc. etc. Could someone enlighten me? Thanks!
Debbye, Spouse Caregiver, Kimberling City/Missouri/USA, February 10, 2006

• Traci -- seeing as your dad was in a clinical trial, he was probably studied pretty thoroughly. It might be helpful for you and your dad to know exactly why surgery is not being considered -- we suggest you ask Dr. David directly for your own understanding. The body, especially one that has been dealing with occluded arteries over time, does sometimes develop collateral circulation to deliver oxygen. This is seen in the heart as well. As for a second opinion, we cannot recommend a specific doctor or practice, but you live in Minneapolis which is a major center for vascular research and treatment, with companies like Guidant, Boston Scientific, St. Jude and Medtronic all there. The Minneapolis Heart Institute is also a major center, and many cardiologists today are also involved in treating carotid artery disease. Try making some calls -- records can be sent around. Again, this may not change the diagnosis -- but it's important for the patient and family to understand the medical situation fully and to work together to reduce any risk factors that are under youyr control (diet, medication, etc.). Let us know what you find out. All our best,
Angioplasty.Org Staff, Angioplasty.Org, January 11, 2006

• My father did suffer a major stoke on 05/2005 (ischemic stroke). We were told his 2 carotid arteries to brain are 100% occluded and now 1 carotid to neck is 100%. However, Dr. Davis at University of Iowa said 20% of stroke patients form a secondary group of arteries that can feed the brain oxygen. My dad was part of COS trial stroke study however his PET scan showed he was getting oxygen to brain. However, we were told surgery was not an option or they were no other options. Is there anywhere else do get a second opinion?
Traci Woollums, Minneapolis, MN, January 11, 2006

• Traci -- can you clarify "he has 2 100% carotid arteries to brain". Not sure what you mean. You say one is 100% blocked -- what is the status of the other? Also is your father symptomatic -- has he suffered any TIAs (small "transient" strokes). And finally why does his doctor say he not operable? Does he have other conditions that would prevent an operation? Or does his doctor feel the risks of an operation outweigh the potential benefits. The University of Iowa is a major medical center, so we would assume the specialist he's seen has carefully weighed all the options. But if he's inoperable due to an additional medical condition (like lung problems, etc.) an endovascular approach might be possible. Without knowing the complete clinical history of a patient, it's not really possible to comment on his doctor's diagnosis, but it's certainly reasonable to ask more specific questions, or even to get a second opinion, if only to satisfy you and your father. Read our interview with Dr. White of the Ochsner Clinic which discusses the stenting option for carotid artery disease for some background.
Angioplasty.Org Staff, Angioplasty.Org, January 11, 2006

• My father is 65 years old and has been told that he has 2 100% carotid arteries to brain and now 1 of his carotid arteries in neck is 100% blocked. The University of Iowa, Dr. Davis said he can not have surgery and there is nothing they can do. I can not believe there is nothing no one can do? Please advise
Traci Woollums, Minneapolis, January 11, 2006

• L.T. -- If the MRA showed a significant blockage in a carotid artery, normally a patient would be referred to a vascular specialist. This used to be a vascular surgeon exclusively, but currently the use of catheter-based (or endovascular) treatment of carotid disease has expanded to the point where interventional cardiologists and radiologists also treat the blockages using carotid stenting. If this sounds confusing, you're right. And to try and avoid the "turf wars" among specialties, more and more hospitals are creating "Vascular Centers" where all three specialties combine forces to decide the best treatment for each individual patient. We at Angioplasty.Org feel this is the best route for patient care. Back to your specific case, Dr. Christopher White of Ochsner Clinic in New Orleans stated in his interview with us that his patients always also see a neurologist to confirm the diagnosis and treatment. Did the neurologist at your hospital advise you on a course of action? You should be able to find help in Houston which is home to the Texas Heart Institute and Baylor, two medical centers that have pioneered treatment in the vascular field. Please let us know how things turn out. Patients' experiences will help others make the right decisions.
Angioplasty.Org Staff, Angioplasty.Org, December 23, 2005

• How do you ask an older pcp Doctor for an angiogram if there is severe blockage on the left cartoid artery without offending them. Should we go directly to a vascular surgeon or cardiothoracic surgeon? What is the prognosis of a female 64 Educated American Hispanic with insurance having any procedure done. We waited an hour and a half in the ER just to be seen after a mild stroke and were not treated, She saw her PCP on Monday put her on plavix sent her for brain MRI then Neurologist then sent for an MRA which is showing opaque white on left. Where do we really need to be seen so this can be taken care of promptly. We live in Houston, TX. Please Help with any advice.
L.T., daughter, Houston, TX USA, daughter (stj509@ev1.net) on Wednesday, December 21, 2005

• What are the reasons for not being able to do anything about a blockage in one side, but can in the other?
Sherry Brown, Kalamazoo, MI, December 21, 2005

• My father has blockage of the carotid arteries. 85% and 55%... They are still doing dye test and x-rays because they say he has a spot that is slightly swelling above the 85% blockage. Is the swelling portion fixed just as easy as the blockage?? Also ... any info on Tallahassee, FL operating facilities would be greatly appreciated.
casey, GA, December 05, 2005

• Steve -- this is NOT medical advice, but you should read our interview with Dr. Christopher White of the Ochsner Clinic. He states that currently CMS, or MediCare, will now reimburse clinically for carotid stenting if the patient meets the following criteria: more than a 70% diameter stenosis of the carotid artery, in a symptomatic patient, meaning either a transient ischemic attack, a TIA or stroke, AND the patient has to be at high risk for conventional therapies or high risk for surgery. Although your mother was looked at a year ago, at that time she didn't fall into any of these categories. We assume she is on medical management right now. While there is the risk of a stroke, it's probably around 2% and that may be less than the mortality associated with either surgical endarterectomy or stenting -- but that can only be determined by an examining physician who has her records and tests in hand. There are several randomized trials going on right now trying to determine the best therapy for asympotmatic patients like your mom. If you are concerned, a consult with a vascular surgeon who does or is associated with a practice that does endovascular procedures like stenting -- or a cardiologist who works with a surgeon -- is the best way to go.
Angioplasty.Org Staff, Angioplasty.Org, November 30, 2005

• In August 2004 my mother, who is now 81, was told she had one carotid artery blocked 60 -70%, the other artery apparently had little blockage. The doctors told me because the blockage was closer toward the brain, it was inoperable. She has had no symptoms other than tiring easily (she also had triple bypass 4 years ago). What if anything, can we do? I don't want to simply wait for her to have a stroke. Is it possible the good artery can compensate for the blocked one, even if it's on the other side of the head? Thank you.
Steve B., Chicago Il. , November 30, 2005

• My father just suffered a stroke on Monday and has been told that a stent is a good option for him but for some reason they want to wait four to six weeks to perform it. Is there any reason why they should wait? I would think that doing it right away might help prevent another stroke and I'm worried that if they wait he'll have a stroke in the mean time. Any opinions would be greatly appreciated.
Laura Moffatt, Quispamsis, New Brunswick, Canada, November 23, 2005

• My husband suffered a stroke about 2 weeks ago, his right carotid artery is 100% blocked is there anything that can be done about this? He is 57 years old and was in excellent health, excerse everyday, ate healthy, no blood pressure problems or cholestral problems, does not smoke or drink. What could have caused this problem?
Lana, Yorktown Virginia USA, October 31, 2005

• Lynn -- are you asking about the risks of the MRA or about carotid stenting vs. surgery? The MRA is a less invasive imaging technique than a carotid angiogram. A carotid angiogram requires a small puncture of the artery (usually the femoral a.k.a. groin artery) for a catheter insertion, as well as the use of contrast dye which some people are allergic to. The MRA is like an MRI and basically is non-invasive. For a large vessel like the carotid artery, an MRA should give a good picture, clearer than ultrasound, with less possibilities of an adverse reaction than angiograms (although even there the risks are low). The precautions for an MRA are the same as for an MRI (they may interfere with pacemakers, and other metallic implants, etc.). The current guidelines for carotid stenting reimbursement specify that a blockage must be at least 70%. If you have any questions, get a second opinion and definitely read our interview with one of the leaders in carotid stenting, Dr. Christopher White of the Ochsner Clinic in New Orleans.
Angioplasty.Org Staff, Angioplasty.Org, October 10, 2005

• Good Morning, My husband age 74 is due to go in for a MRA of the carotids. His ultra sound said 50 to 60% blockage of the right side. What are the danger risks of having this done?
Lynn Spurrier, American Legion, Piscataway N.J., October 10, 2005

• I have had both carotid artery procedures. In 2002 with surgery and in August 2005 with a stent. Believe me the stent is the way to go. There are certain conditions that you have to meet to qualify for Medicare to pay for the stent and the Doctor. Maybe other insurance carriers also have criteria that has to be met. Doing the Stent procedure it is all over in a few minutes with little or no recovery. I did experience some tenderness in the stent area for about 10 days and the Cath site has some discomfort BUT nothing compared to the recovery time and pain for the open surgery, not to mention the scar which good be a problem for some folks. Hope this helps someone.
E Eslinger, Deltona Florida, October 7, 2005

• Dear E -- has your pain resolved itself? As you know, Carotid Artery Stenting is a relatively new procedure and our readership has many questions. We appreciate patients sharing their experiences with each other.
Angioplasty.Org Staff, Angioplasty.Org, October 4, 2005

• Pain after Carotid Artery Stent. I had a CAS done 4 days ago and having some pain in the Stent area. I was told by the PA that this would go away in a few days. Anyone out there with this problem?
E Eslinger, Deltona, Florida USA, August 20, 2005

• Hi..I am looking for people who have had 'carotid artery surgery. Sounds scary to me?...Thank you...
Pat, East Marion, NY USA, August 17, 2005

• My father is 81, he has had 4 TIAs they have found that one of his carotids is 100% blocked and they can't do anything. He has a pacemaker/ICD in his chest and has had triple by-pass several yrs ago. Right now he is still driving and taking great care of himself and I just don't understand why they say nothing more can be done?
Lana, Rockport, Texas, USA, June 24, 2005

• Karen -- Studies have shown that carotid surgery in the appropriate patients definitely lowers the risk of stroke. There are ongoing randomized trials to see the extent to which carotid stenting does, but trials already have shown stenting to be equal to surgery for patients who are at high risk for surgery (poor health or other compromising clinical conditions). The current state of stenting is that the FDA approved the Guidant ACCULINK™ / ACCUNET™ Carotid stent and embolic protection device in August 2004 (you can read the FDA approval here). It is currently the only approved carotid stent, although there are others in clinical trials. Medicaid recently announced expanded reimbursement for patients who meet the following guidelines: high risk for surgery with symptomatic carotid artery stenosis of 50-70% OR asymptomatic high risk patients with carotid artery stenosis of 80% or more. Outside of these criteria, a patient would need to be enrolled in a clinical trial: the CREST Trial and ACT I (just beginning). It sounds like your mother is on the borderline for these indications. Just curious -- what was the specialty of the doctor who did the diagnosis? And did he discuss surgery (endarterectomy) or stenting? A big question is the state of the patient's health and whether or not they are "high risk" for surgery. As always, nothing on this site should be taken as medical advice -- a doctor is the only way to get accurate information, but by all means get a second opinion if you are concerned (most doctors will welcome that -- see our interview with Chris White, MD, of the Ochsner Clinic in New Orleans -- in particular the last section about second opinions). Let us know how things turn out.
Angioplasty.Org Staff, Angioplasty.Org, May 13, 2005

• My mother will be 70 years old this month and just had an MRA and an angiogram and has a 70% blockage in her left carotid artery and 50% blockage in her right. Her physician is suggesting that we wait until she has a higher blockage before doing surgery. She has high blood pressure and has had more than one sibling pass away from a stroke. Would not a carotid stent procedure done now be better than waiting for a complete blockage and then doing surgery? Should we consult another physician for a second opinion?
Karen Weldon, Broken Arrow, OK, May 12, 2005

• My grandfather was just diagnosed with 100% blockage in one of his carotid arteries after being admitted to the hospital with a TIA. Up until now he has been in fairly good health. According to the reports the other arteries are clear. We are told that the blocked artery is inoperable. The hospital is thinking of releasing him to go home. Is this a good idea? Should we get a second and third opinion before he leaves the hospital? What are his risks for additional strokes from the 100% blocked artery? Thank you Keith Steidle
Keith Steidle, Bridgewater/NJ/US, May 07, 2005

• For anyone interested in the field of carotid stenting, read our interview (posted today) with Dr. Christopher J. White of the Ochsner Clinic in New Orleans. He's one of the leaders in the area of carotid stenting and this week is conducting the 14th Annual "All That Jazz" meeting on Peripheral Angioplasty.
Angioplasty.Org Staff, Angioplasty.Org, , April 28, 2005

• Ilana -- we don't store such data here, but I would call the Arizona State Health Department or go to their web site to see if they track these statistics. I do know that the Arizona Heart Institute in Phoenix is one of the pioneering institutions in the country regarding endovascular (catheter-based) treatment of vascular diseases. Its founder, Dr. Diethrich, appears in our video documentary "Vascular Pioneers". Their web site is www.azheart.com -- we're not recommending them necessarily (we can't really do that) but they are a center of training and research in this procedure.
Angioplasty.Org Staff, Angioplasty.Org, , April 14, 2005

• My mother 82 yrs old has 100% blockage of left carotid and 75% occlusion of right carotid. She has diabetes and high blood pressure which are controlled by medication. She is being advised to have a carotid stent procedure. Can u recommend urgently the hospitals in Arizona with the lowest complication rates?
ilana, Tuscon, Arizona, April 14, 2005

• We regularly perform here carotid angioplasty and stenting. This is an extremely safe and effective procedure. This is done by an interventional radiologist. Dr. Siba KMCH, Coimbatore
Siba, Coimbatore, Tamilnadu, India, April 04, 2005

• Carotid artery disease is the same disease process that causes coronary artery disease -- narrowing of the arteries, or atherosclerosis. If you have the disease in one part of your body, chances are you have it in others. As with all these types of diseases, the first line of defense is to reduce risk factors: stop smoking, adopt a healthy diet, lower blood pressure, cholesterol, etc. Some of these can be helped with the proper medications. But at some point the narrowing may begin to restrict the blood flow or increase the risk of heart attack or stroke. One type of stroke can occur when the carotid artery becomes completely blocked. The fix for that has always been a surgical procedure called an endartarectomy, where the surgeon make an incision in the neck, opens the carotid artery and literally cleans it out -- sounds complicated, but it's one of the most widely performed surgical procedures around -- almost always performed by a vascular surgeon. As with heart disease, now a balloon and/or stent has been developed that can open the carotid artery from the inside out, using a catheter. Carotid angioplasty usually is performed by an interventional cardiologist -- the same specialist who balloons the heart! If this sounds confusing, you're not alone. We covered the subject of "turf wars" and competition in Part Two of our documentary, "Vascular Pioneers: Evolution of a Specialty", especially Chapter 5.

Initially considered inferior and potentially dangerous, when compared to traditional open surgery, today carotid angioplasty has gained in sophistication and safety to the point where several studies show little difference in the outcomes (see our report from the TCT 2004 meeting). Currently, carotid angioplasty is being done primarily on patients who would otherwise not fare well with surgery due to a compromised health condition (pulmonary or otherwise) but the patient population is constantly expanding as new devices are developed and perfected. Cartotid angioplasty and stenting will be the subject of an upcoming feature on Angioplasty.Org. Meanwhile we encourage readers to write in their experiences with this procedure. Thanks.
Angioplasty.Org Staff, Angioplasty.Org, Feb 10, 2005

• I have a 100% completely blocked right carotid artery. What are my symptoms, tiredness, i just don't know. Please reply.
Denise, January 15, 2005

• My father is 76 years old with a history of heart disease. He had a quadruple bypass 9 years ago. He is taking aspirin, Plavix and other medications. He was told an MRI done a few weeks ago showed complete blockage of left carotid artery, the right artery shows slight narrowing. Upon seeing a vascular specialist, he recommended that my father have an angiogram with plasti stent procedure done because he is at risk of having a stroke. I'm worried that the procedures themselves may put him at risk for heart attack or stroke. Any comment would be appreciated, very concerned for my father!
LIZ,, New York, NY, USA, November 02, 2004

• I require details of anyone who has recently undergone Angioplasty / stenting of the carotid artery in the neck region. This is really urgent please.
Rana, NSE, Mumbai, August 20, 2004

• My father, age 92, is about to undergo a carotid artery angioplasty (balloon, not stent) and has only one kidney. He has had bad reactions to the dye in two angiograms, one only a week ago. If you hear of any alternatives or precautions, could you please pass them on to us? Thank you.
Marjorie Spitz, Aquinnah, Massachusetts, 29 Apr 2004

• Hello, I would like to know what's today the medical position about angioplasty of the internal carotid. What's the advantage of this intervention in the duality with the traditional endarterectomy?
Ramboux, Brussels, Belgium, 04 Nov 2003

Should a 44 year old person with an asymptomatic aneurysm of the carotid artery (not susceptible to surgery due to its location under the skull) wait for drug-eluting stents to be available for the carotid artery or get the bare metal stent(s), perhaps with coiling, now.
M. Burke, Boston, Massachusetts, 04 Apr 2003

Three years ago I had a stroke where for 15 min. my left side went numb and later we found out my right carotid artery had completely blocked and died. I went in about 4 weeks ago and they say my left carotid artery is now blocked and died. My doctor says the two arteries in the back of my neck have picked up the blood flow. He has told me to diet and sent me home. He says in about 7 weeks to call and they will check my kidneys to see if that is what is causing it. I have high blood pressure, high cholesterol and diabetes. I am concerned with the prospect of just go home and wait. I don't want to loose anymore arteries along with dieting what else should I be doing what tests should I ask for and isn't there anymore they can do. I am worried that the two smaller arteries will give out... Then what?
Lori Nadelle, Albuquerque, New Mexico, 13 May 2002

• Carotid angioplasty is a procedure that is being used in some cases instead of the surgical approach, called carotid endarterectomy, which has been the main treatment of carotid vascular disease for many years. In a presentation last month, Dr. Gary Roubin of Lenox Hill Heart & Vascular Institute in New York said that in his institution the current risk of stroke or death during carotid angioplasty is currently less than 3%. It used to be almost double that. The statistics, however, are HIGHLY dependent on the skill and experience of the operator -- also as to whether a distal protection filter of some sort is utilized. You are certainly on the young side to have this procedure -- normally for patients 55 and older. But we always recommend consulting with your doctor (any information on ANY web site is no substitute for that) and by all means getting a second opinion if you feel as if you need confirmation.
Editor, Angioplasty PTCA Forum, 17 Feb 2002

• I have had a heart attack from 4 years ago and had stent in the right cornary from a few months. I got angina and fainted for about 3-4 minutes several times (about 3 times within 2 months). I did angioplasty and my doctor said that I have a narrowing in my left carotid in my neck but he can't do stent in that artery because I was born with this narrowing and aspirin will help. I'm not sure about what he said and need advice.
Hanafy, Cairo, Egypt, 14 Feb 2002

• I am a 32 year old female who has been experiencing TIA symptoms. After COUNTLESS tests, an MRA found that I had a 60% narrowing of my right carotid artery, and what would happen is that when my blood pressure, or pulse got too high, my blood flow was being diverted, a "steal" my doctor called it. She is now scheduling me for an angiogram, and probably an angioplasty. Because this is an artery to my brain, is there a risk of stroke during the procedure? How likely is it that I will have to do this again? Any advice or insight is SO welcome, I have a 2 year old son, and a husband I want to grow old with. Thanks!
Nikki Ferry, Presque Isle, Maine USA, 14 Feb 2002

The following related archived posts have been moved to this topic:

• Can radiation therapy used in a radical neck surgery cause problems with the carotid arteries? Angioplasty was done years ago and a reoccurance has happened. What procedure is used to correct a narrowing of irradiated caroid arteries and who is an expert in that area?
A. F. Hardee, Brewton, Alabama, USA, 1 Dec 2001

• Thank you so much for your quick response. I appreciate your sending the HTML along with your thoughts. My family and I will look over this information and formulate our questions. I am going with my father to his conference appointment in a few days. Your site is very informative and I am thankful that you have taken the time to make it available for the layperson as well.
posted by Debi, Manitowoc, WI USA, 2 Apr 2000

• debi -- We're in the process of posting national stats for angioplasty, but your situation is obviously immediate, so I have taken the liberty of sending
you an HTML page [in PDF format] showing National statistics. As you can see, the age groups are 65-84 and 85+. Mortality in hospital is 1.4% and 4.5% respectively. We cannot make any recommendations, (please read the disclaimer on our site) but have your father's case looked at by an interventional cardiologist who is experienced in doing cases (don't be afraid to ask " how many have you done" and "what is your success rate with patients of this age"). As with any procedure, there are risks. Carotid (neck) angioplasty is much newer and more controversial than coronary angioplasty, but it is a growing field. Let us know what happens.
Editor, Angioplasty PTCA Forum, 1 Apr 2000

• My father had a heart attack last July with minimal heart damage. He is 84 years old but has always appeared and acted much younger. For several months he has been experiencing chest pain and recently had testing done for carotid artery blockage. He has blockage in his neck and the left side of his heart. His first cardiologist stated angioplasty was not an option due to my father's age, and that there was too high a risk of him not surviving the procedure as he it would induce cardiac arrest. The new cardiologist stated he does not consider age, but rather physical condtion, and is pushing for this procedure to be completed within two weeks. Has anyone had this procedure in their 80's and what can you tell me about the outcome? Thank you.
posted by Debi, Manitowoc, WI USA, 1 Apr 2000

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