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Carotid Artery Stenting (CAS) -- 2007 and Earlier
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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. • 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? • 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.... • 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. • 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. • 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. • 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 • 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? • 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. • 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. • 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. • 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. • 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. • 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. • 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? • 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? • 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. • 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? • 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 • 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. • 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. • 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. • 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. • 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. • 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. • 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? • 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. • 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? • 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? • 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. • 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. • 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. • 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?? • 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) • 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. • 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? • 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. • can any surgical procedures be performed on a
100% carotid blockage situation? • 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. • 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. • 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? • 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? • 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. • 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. • 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. • 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. • 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! • 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. • 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. • 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. • I had radiation to my neck years ago. I now have
carotid artery stenosis. What procedure is needed to clean out the carotids? • 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? • 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? • 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! • My left Carotid Artery is 100% blocked & my right
Carotid Artery is 50% blocked. Is there any thing that should or can be
done? • 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? • 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. • 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. • 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. • 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. • 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.) • 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 • 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? • 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. • Victor -- did the MRI or CT show any blockage
in the carotid?? • 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??? • 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? • 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. • 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? • 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. • 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? • 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? • 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? • 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! • 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, • 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 -- 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. • 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 • 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. • 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. • What are the reasons for not being able to do
anything about a blockage in one side, but can in the other? • 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. • 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. • 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. • 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. • 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? • 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. • 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? • 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. • 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. • 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? • Hi..I am looking for people who have had 'carotid
artery surgery. Sounds scary to me?...Thank you... • 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? • 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. • 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? • 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 • 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. • 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. • 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? • 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 • 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. • I have a 100% completely blocked right carotid
artery. What are my symptoms, tiredness, i just don't know. Please reply. • 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! • I require details of anyone who has recently
undergone Angioplasty / stenting of the carotid artery in the neck region.
This is really urgent please. • 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. • 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? 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. 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? • 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. • 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. • 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! 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? • 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. • 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 • 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. |
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