Carotid Artery Blockage`

[AdelleWest]

My husband is 64 years old; has not smoke since 98; doesn't drink or do drugs.  He had a triple bypass in 98 and just last week had a carotidectomy on the left front which was 60% blocked.  Both front and back arteries on the right side are 100% blocked.  The left back is ok.  What is his chance of a normal long life?   We both love to go on cruises; does this stop our traveling?   My main concern is what is going to happen to him?  

[ed34]

I assume that like coronary arteries, there's no way of knowing how much scar tissue will form inside the artery after repair. Obviously the smaller the vessel, the more hindrance the scar tissue will have on the blood flow. At least with stents, you get a drug coating which helps to inhibit scar tissue formation, but that only touches about 10% of the artery lining.

[WRPH]

I have left carotid artery surgery in 2003 because it was 80% blocked. The cardiothoriac doctor did the incision, cleaned out the artery, had to put a patch on it, said it was the smallest artery he had ever seen. Then in 2008, age 59, I had lost consciousness, hit the back of my head, had a hematoma, concussion and I had a stoke from that same carotid artery without any severe damage. Didn't really know I had a stroke until last week and some TIAs recently. The stroke was old. I had an 85% blockage in the very same location that the surgery was performed on. This time another cardiothoriac doctor did the surgery and inserted a stent into the area. Everything went fine and was told it will take a long time for the stent to block because it is so big. I am 62 years  old now.

[ed34]

I'm not quite sure what he meant by that comment. When they perform an arterectomy on a carotid artery, they now deploy a shunt. This is basically a tube which takes blood from below the blockage, and re-enters the artery above the blockage, bypassing it. This means the blocked area of vessel runs dry, allowing surgery to take place with no clots getting to the brain. In reality I can't see how it makes a difference if the blockage is 70%, 80% 90% or 100%. Once cleansed, the artery is stitched back together and the shunt removed. Perhaps they mean something else, but I would ask about it.

[AdelleWest]

Also, his surgeon commented that if those 100% blocked arteries had been 99%, they could have cleaned them out, but once they reach 100%, it's too risky, as some clots can cause a major stroke if they get to the brain.

[AdelleWest]

chatter, the surgeon did not mention stenting for the 100% blocked arteries.  He said it was way too risky to go into those after they are occluded.  

[AdelleWest]

Thank you for your reply.  He had a very good surgeon and the surgeon did comment that he would see him again some day.  He also told him though that he hoped he would not need any more surgery for a while.  We both wondered what he meant and were not bold enough to speak up at the time.  Now we wish we had of.  We see him again July 6 for a follow up from the surgery.  I will definitely ask what he meant.

[ed34]

There are risks yes, but generally if one side is open (both arteries on one side) then the brain will receive enough oxygen anyway. The risk comes from strokes. Now, with plaque, by far the highest occurrence of rupture which causes strokes or heart attacks, comes from incomplete blockages. This is because the blood rushing over the plaque alters in pressure and flow rate, and of course the artery constricts and expands to adjust this. With 100% blockages, the situation is usually far more stable. Blood is pushing on the back of the blockage, but plaque is too hard to be moved. A 100% calcified blockage will not allow the artery to constrict or expand either. The main issue here is that there is no real backup. If the side which received surgery blocks again, then there are no other vessels to feed enough oxygen to the brain. Of course, a blockage doesn't form over night, so your husband just needs to watch for signs of trouble, such as dizzy spells etc. Another important factor is to keep systolic blood pressure down, usually below 140 is recommended.
I doubt if stenting these arteries will be an option as they are 100% and it's likely the plaque is very hard, too hard to pass a guidewire through. I believe if Doctors felt intervention was necessary, they would recommend another arterectomy. It is very likely that the Doctors will leave them alone and just monitor the existing arteries, or see if your Husband develops symptoms showing they are beginning to block again. I doubt if he will.

[Flycaster305]

I'd ask for a second opinion.  As ChatterAlly suggests, there are differences of opinion regarding carotids.  I know from personal experience that being away from home when a life-threatening emergency occures is extremely stressful.

[ChatterAlly]

Have they mentioned to you the options such as stenting the carotids?  My right side is about 70% blocked and they are telling me they won't stent it unless it is 80% or better. One doctor is telling me I should have this taken care of, the other (cardiologist) is saying, no. Not at that point yet.