Question Title: Alternative treatments for carotid stenosis?

What are some of the causes of carotid stenosis? My colesterol is great (both good and bad). I've been reading that arteriosclerosis can be caused by clymedia and/or other bacteria or viruses. Can I be tested for this? Please don't just write me off and say, oh it's probably congenital. If I've inherited something, then it's a weakness of some sort and I want to get to the root of it. My doctor has also suggested that I may have fibromuscular displagia and I can't find this ANYWHERE. He described this as being a weakness of the inner lining of the artery wall. Is there another name that this might be called?

My doctor has ruled out MoyaMoya because there is no "puff of smoke" on the MRA but it is my understanding that it won't show up until the arteriogram. Is this correct? (My last angiograms were done 21 years ago and thanks to American efficency have been destroyed!) MoyaMoya needs to be ruled out as a Dr. told me 21 years ago I MIGHT have it.

As I've implied, I have a LONG history, mostly uneventful until recently. This time around I want to make well researched, informed decisions knowing exactly what my alternatives are to angioplasty and/or surgery. 21 years ago I had the STA/MCA bypass and, yes, it is still operational! Having been through this once, I want to look at preventative measures that might be effective.

My research has turned up a doctor in Florida who is treating carotid stenosis with ultrasonic therapy. Do you know anything about this? Has any studies or extensive research been done on this procedure? His results look very promising and worth a try but more info would be appreciated.

Thank you very much for your reply and the fact that you even made it down to this point in this lengthy missive. (Sorry, brief is not my middle name!)

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Your case is quite complex. Moyamoya and fibromuscular dysplasia are special cases of vascular disease which can lead to occlusion, but actually are a lot less common than atherosclerosis.

Cholesterol and lipids don't have as clear a relationship to cerebrovascular disease as they do to heart disease. I don't know about chlamydia. Bacterial infections have turned up in surprising places (witness the story with helocobacter and peptic ulcers) but I don't know what the current state of understanding is regarding the contribution of infectious causes to cerebrovascular disease. Certainly, there are genetic factors but even if you had a clear family history to support that, I'm not sure what we could offer to counteract the underlying problem.

Moyamoya affects the terminal carotid and the large trunks of the ACA and MCA. You end up with no visible large arteries and a whole lot of smaller ones which take off directly from the carotid. It is this which leads to the "puff of smoke" appearance on arteriogram. I've seen only a few cases of moyamoya, but I'd venture to say that if you really had it 21 years ago, it is likely to have progressed faster than it has. Could you have it now? Possibly, but the angiogram would tell the story pretty convincingly. The cause is not well understood.

Fibromuscular dysplasia (FMD) also has a characteristic appearance (beaded) on arteriogram. If you have it, I suppose your doctor would be able to tell from the films.

I don't know about alternative therapy. I think you are wise to question whether angioplasty is appropriate, as that is a serious step. Probably the most direct way to get information which fits your case specifically is to see a stroke specialist. Of course, we have some at the Cleveland Clinic (800 223-2273, ask for 4-5559) but there are also other excellent centers in the country. You want someone who really specializes in strokes and vascular diseases because of the complexity of your case (prior EC/IC bypass, possibility of Moyamoya, complete occlusion of one carotid, question of FMD, etc). You want answers such as: should you be on coumadin, what are the risks and benefits of angioplasty, etc.

As you know, this information is provided for your medical education only. Specific comments regarding diagnosis, treatment options, and prognosis must come from your doctor after appropriate evaluation. I hope this helps. CCF MD mdf.