Both carotids occluded

[Calusa]

I am an overweight 68-year old male with a recent history of hypertension.  A recent ultrasound exam found my right carotid 100% occluded and my left 50% blocked.  I am currently on two blood-pressure reducing drugs, 40mg Zocor, and 81mg aspirin.  My internist suggested annual retesting of left corotid.  Is this frequent enough?  Should I see my cardiologist and what other types of tests should I request for a valid second opinion? Is there a better drug regimen that I can follow? What other steps can I take, other than diet and exercise, to reduce trend of increasing occlusion of left carotid artery?
Thank you.

[lmroswell]

Have you had an MRA done?  That gives a better picture of the occlusion v. ultrasound.  According to the neurologist that we just saw, there are two options for the carotids.  Endarterectomy and stenting.  The neuro suggested that for stenting, to go to an academic center preferably up north somewhere.  If you are in FL, as we are, she said not many doctors in FL do that type of surgery (stenting).  As for the endarterectomy (not sure if that is spelled right) that is done here all the time, but you do want to find a surgeon with much experience.  Have you had studies done on your vertebral arteries?  Just curious.  Take care...

[Calusa]

For a historical discussion of my carotid occlusion I offer the following:  About four years ago I awoke to find I had lost some vision in my right eye.  I immediately visited my ophthamologist who diagnosed Holenhorst plaques and suggested I have both carotid and heart Doppler studies.  These were conducted in my cardiologist's office facility and at that time the right carotid was found to be 76% occluded.  I was given Zocor 20mg and aspirin 81 mg but no follow-up studies were suggested.  About 10 years prior, this same Dr. put me on Toprol for arythmia control (this has since been changed to Atenalol by my internist for economic reasons -- mine).  This drug had worked well.  My internist at the time was mute on any further diagnosois or future tratment -- so I changed Drs.  When I was recently restudied for carotid condition by my internist (2nd time by him) my BP was high -- 185/92 -- despite the BP medication I'm taking -- about a year ago a Holter monitor proved to show normal range of BP (with meds).  For several weeks prior to the 185/92 reading I had been under severe personal stress, for which he and I blamed the rise.  Nonetheless he upped my Diovan another 60mg and when I checked my BP today (twice) it was 125/70.

For  CCF-M.D.-bkj
Does the Cleveland Clinic in Naples, Florida, have a cardiologist that specializes in peripheral vascular disease on staff?  Thanks to everyone for all  the feedback.

[lmroswell]

Thanks for responding.  At this time, because only one carotid is 70% blocked, they are not recommending surgery.  The doc said the stats for stroke are higher with surgery with a 70% block, than if you were to do nothing.  So, we are not going the surgical route on the carotid right now.  My mother's major problem is the blockages with both vertebral arteries, 50% and 70%, and is showing symptoms for those blockages.  As far as I have read, surgery on the vertebral arteries is almost never done, only stenting.  It is, as I have read, a delicate procedure.  I was wondering if anyone had statistics on the percentage of blockages on the vertebral arteries and stroke, and at what point would stenting be recommended.  Thanks for writing...Lisa

[chapo]

Hello, has your surgeon discussed a Carotid Endarterectomy
with you. My father has a similar problem and was told the risks
outway the benefits when one of the carotid's is occluded. The internet has many pages of conflicting info on Carotid surgery.

[lmroswell]

My mother just had an MRA done which indicated that the right carotid artery is 70% blocked and both vertebral arteries are blocked, 70% and 50%.  She is symptomatic in that she has dizzy spells.  We saw a neurologist today that prefers to treat her medicinally v. surgical procedures.  She will now be on Plavix, Lipitor 80 mg., and a folic acid supplement.  She is also currently on Toprol 50 mg. for HBP.  Does anyone have any information on websites or possible prognosis for this diagnosis?  I've heard that there are two types if causes for the stenosis.  One, by the build up of platelets, and two, the build up of plaque.  If the cause of the stenosis is from a build up of cholesteral plaque, would the Plavix do her any good?  She's been through a lot, two mastectomies, open heart surgery, and now this.  Any information would be greatly appreciated.

[VikingColumbus]

Hi,

100% occlusion of a carotid artery?

So only one artery provides a limited
avenue for blood to your head?

This is most curious. Do you have fainting spells?
Vision problems?

This is a serious question on my part. I've seen
a medico program where a procedure was done to
excise a blockage from a carotid and the fatty
thing that emerged was similiar to a thin cigarette.
Has that been tried or proposed for you? Or is that
option prohibitive for you for medical reasons?

[Healthyself2]

There are studies underway which show a regression of cartoid narrowing with high doses of intravenuous synthetic HDL.

Many other studies have shown that increasing HDL can stop the progression of or regress arterial plaques.

The three ways to significantly increase HDL currently are exercise, alcohol, and high dose niacin, although a drug designed to raise HDL is expected to come to market in 2005 or 2006.

High doses of Niacin will cause flushing and the no-flush Niacin is not effective.  I take 1500mg of perscription Niaspan and walk 3 hilly miles per day, plus do a bit more on the weekends.  I've brought my HDL up from 29 to 50-55 and seem to have arrested my coronary artery disease.

Also, if you don't have rythm problems, I would not use a beta blocker as my first choice for reducing BP, unless you are sedentary.  If you are sedentary, your arteries will continue to narrowl, no matter what you do.

Best of Luck

[hankstar]

They are an excellent medications for controlling HBP. I am also on Atenolol 100mg daily in divided doses and Cozaar 50mg daily which is an ARB very similar to Diovan. You medications sounds good, hopefully things will go good for you.


Best wishes.

[Calusa]

As I stated, I am on two high blood pressure medications but I omitted their name.  These are: Atenolol 100mg and Diovan 160mg.
Thanks for pointing out my error.  Calusa

[hankstar]

Hi,

  You said you have hypertension and is on Zocor and aspirin,no disrespected intended , they are not anti hypertensive drugs, zocor is a statin for lowering cholestrol and 81mg of aspirin is basically an antiplatelet therapy for one with heartdisease and that has suffered a heart attack , usually (2) 81mg tablets is used now instead of just one.

  Maybe a beta blocker and a ace inhibitor or ARB , along with a duretic(often called a water pill) such as Esidrex(hydrochorthiazide) would help with your HBP. Bear in mind that I am no doctor and they are alot of anti hypertensives medicines out there, your doctor would know best what to prescribe.

Good luck.

[Cleveland Clinic]

Calusa,

Thanks for the post.

Given the severity of your carotid disease it is probably worth evaluation through a cardiologist that specializes in peripheral vascular disease.  Ultrasound is an external measurement and there are a small percentage of patients with what appears to be total occlusion, that actually have high grade stenosis of the artery.  Further imaging could help confirm if this is the case and what options may be available to you.  

Specific drug suggestions are out of the realm of this forum, but in general you should have aggressive lipid control, strict blood pressure control, and be on an antiplatelet agent such as aspirin.

Carotid atherosclerosis is the same process as that which occurs in other vessels such as the coronary arteries so control of the risk factors which influence the progression of this disease such as cholesterol, weight, smoking can all play a role in decreasing the rate of progression.


good luck