My mother had been diagnosed about 3 years ago with a certain blockage in the Cartoids.
She is today 78 years old, she also some more medical problems like blood pressure
and cholesterol but she is generally balanced with medications.
In the last dopler test she found to have 85% blockage in the left carotis where it was 70% two years ago, she also around 50% blockage in the right carotis but that remain unchanged from 2 years ago
She also made an angio CT that confirmed the situation.
Her major complains are: dizziness and heavy legs feelings.
Recently she met a doc who is expert in Carotid stenting that recommended her to do stenting.
We know that also Carotid Artery Surgery is an option and even also more common option then stenting.
I would be pleased if someone here would be able to answer the following:
1) How really critical is to make an intervention ?
2) is it really required in this age ?
3) I assume that there is a plaque also in other arteries in the body,so what is the point to remove it in the cartoids when it might remain a danger in other places ?
4) what is the safest practice today - surgery or stenting ?
1. Very, her symptoms are conclusive for the treatment to be required. Her symptoms will only worsen as the blockage increases and we are talking about important nutritional and oxygen supply to the brain.
2. Your Mother is 78, and it is very unlikely that the blockage will increase. So far it seems to be showing 5% per year, and if it blocks much more, her symptoms will worsen and can make her life hazardous through falling etc. We also don't want to see areas of the brain suffocate and die through lack of oxygen. It is likely that your Mother will live longer than another 2 years, so why not have the procedure. Without it, I think she will suffer damage.
3. There very likely is plaque in other arteries, just as there is with most of the population. This doesn't mean we shouldn't treat someone to save major organs. She has a good blood supply to the blockage, which means once removed, the brain will get a good supply again. As major organs start to suffer and give symptoms, then the plumbing can be sorted out.
4. Both are the same with long term prognosis. Surgery is always more traumatic than stenting, and can carry risks such as infection etc. Short term, there is a very slightly higher risk of stroke with Stenting or a very slightly higher risk of heart attack with surgery. The differences are so small with new studies that they can really be seen as the same.
Personally due to infection risk, I would opt for the stent. This will be much less traumatic on your Mother, and due to age, probably one of the main reasons it was recommended.
Have they said about doing both arteries? or just the 85%?
I think that the doc talked only about 1 stent to the artery that blocked in 85%.
one more question -
I understand from reading that there are acctualy 2 arteries that supply oxgynen to the brain and that the are limked together in the brain, does it mean that if only one side is blocked then the brain can still get the oxgygen that it beeds from the other side ? and if so, than why to make an intervention ?
Are you aware of a new study that came out just this month? I am quoting:
"The study enrolled patients who had 70 to 90 % narrowing of the arteries in the brain and had already experienced a mild stroke or a stroke-like event called a TIA ...... The scientist expected the stent to decrease the risk of stroke in patients also receiving aggressive medical management by 35% over two years. Instead 14.7% of patients who received the Gateway-Wingspan stenting system had a second stroke or died compared with the 5.8% who only took medication and modified their lifestyle."
I think "modifying their lifestyle" is the big thing here though. These patients all had a "lifestyle coach" who called on the families twice a month to follow up.
I have no website. It was a National Institute of Health study called "Stenting versus aggressive medical management for preventing recurring stroke in Intracranial Stenosis" Dr Shiam Prabhakaran at Rush Medical Center in Chicago was in charge of one of the two sites in Illinois were the study was conducted. But the operating term here, I think, is "Intercranial", now you'll have to find out whether that applies to Carotid arteries as well.
The brain is the biggest oxygen guzzler in the body, and uses 20% of what is in the bloodstream. Any significant blockages to the brain will cause problems. I personally don't think a 50% blockage is a problem because arteries are larger than they need to be. So if you imagine that the reserve in the artery 50% blocked has been used, you are then looking at the remaining artery which is well over that, at 85%. I would say there is not enough blood reaching the brain.
I mean to - Carotid endarterectomy , which is - Carotid Artery Surgery.
Do you if this is more or less risky compare with stenting ?
I am not sure that this is considered as a brain surgery. Is it ?
I just want to undersatnd what is less or more risky - Carotid Artery Surgery or Carotid Artery Stenting.
brain surgery? The carotid arteries are in the neck so it isn't considered brain surgery. The risks from surgery or stenting are about the same but for your Mothers age, I would say stenting is a better solution due to less trauma and less risk of infection.
The following is from from an International Carotid Stenting Study.
"The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858).
Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4·0%) events of disabling stroke or death in the stenting group compared with 27 (3·2%) events in the endarterectomy group (hazard ratio [HR] 1·28, 95% CI 0·77-2·11). The incidence of stroke, death, or procedural myocardial infarction was 8·5% in the stenting group compared with 5·2% in the endarterectomy group (72 vs 44 events; HR 1·69, 1·16-2·45, p=0·006). Risks of any stroke (65 vs 35 events;
HR 1·92, 1·27-2·89) and all-cause death (19 vs seven events; HR 2·76, 1·16-6·56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal,
in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0·0197).
Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery."
"Suitable for surgery" is the operating term here and. after all, it is a statistical thing.
Could you tell what are the symptoms she is supposed to feel that justify surgery or stenting ?
As I said, her complains are usually: dizziness, heavy legs.
Also the doc suspect that she is suffering from Spinal stenosis and this is why she is going to have MRI soon.
My opinion (and I am not a doctor and am not even married to one): We are now taking about tree different diseases here affecting the brain and meningioma and brain atrophy have nothing to do with your original post about need for surgery/stenting due to blocked or partially blocked carotid arteries which present a risk for a future stroke.
Does athrophy is reversible after a succesfull surgery/stenting ?
ed - would you still recommend stenting over surgery with this condition ?
ed - you said in previous reply "Your Mother is 78, and it is very unlikely that the blockage will increase" - what do you mean ?
My apologies, I meant 'LIKELY' not unlikely.
A Doctor will usually recommend Stenting if endarterectomy looks to be too risky in a particular case. The initial blockage of 90% is only 6mm long which is quite small in length. However, if an artery has tight curves, this usually puts the favour towards having endarterectomy, but obviously the Doctor doesn't feel this is a problem with your mother. Stenting is also recommended if there is a possibility there has already been a stroke, maybe the atrophy is leading your Doctor to believe stenting is the best solution.
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