Carotid Artery Disease

[naturelady]

I am so confused and worried. I am 60 years old and have carotid artery blockages of 50% and 69%. When I asked about surgery to remove the plaque, the cardiologist said that the blood flow was good so surgery is not needed. He said to just watch with ultrasound every 6 months. My deceased father had many tia incidents. I have many health issues, but the thought of a stroke is my worst fear. Has anyone else been told this same thing?
Thank you.

[ed34]

There is a high risk of stroke with carotid artery stenosis and although the blockages are not severe (although 69% is pretty close), that risk remains. Aspirin will help to some extent but usually something stronger is added to this to ensure clotting risk is kept to a minimum. I too would feel concerned and for the sake of a 1% difference, they are not taking intervention measures. There are two possible options for your carotid disease with regards to intervention. The first is an 'endarterectomy'. They make an incision in the artery and remove the plaque, usually along with the inner layer of artery tissue. Over time and on anti coagulants, you grow a new artery lining. This procedure is low risk and there is a low risk of stroke during the procedure. The biggest risk is damage to the nerves running alongside the artery, but with techniques today this is rare.
If you are considered an non ideal patient for this procedure then Stenting using Angioplasty is the second option. Using a Catheter they pass a stent into the artery and balloon it with pressure against the artery wall, and the stent holds the plaque in the artery wall while holding the artery open. This is a higher risk than the arterectomy but still low. The problem occurs if the catheter dislodges some of the plaque, which could of course cause a stroke of any extent.
It is good that they are going to monitor the condition of the blockages every six months, but of course this does not guarantee a piece of the plaque will not break free. Have you asked them what risk you are at if you stay as you are, and the risk if you have an arterectomy? I'm sure you are at higher risk through having no surgery. Yes there is a chance the plaque will not fracture and a chance it will never fracture for the rest of your natural life, but as nobody can say IF this is the case then it will haunt you. Perhaps your GP can put some leverage onto the hospital Doctors? explain how scared you are and the risks cause high anxiety. A GP has more clout than you think with hospital Doctors, mine has often got me into an angiogram suite within a week. You could also
look up the medication you are taking on the internet, look at the side effects and risk factors. Some anti coagulants carry a high risk of causing internal bleeding. So with a lot of ammunition and your GP behind you, maybe you can push for intervention. The fact that there is also family history of strokes is a bonus for your ammunition.
I believe in the states, the rule of thumb is 70% and above should be intervened, any which are 50% and below are treated with medication. I have not seen the rule which covers 51%-69%, perhaps there isn't one? and the decision is made by the doctors.
Oh, as a last matter, it has been proved that the arterectomy of a stenosed carotid artery is beneficial for patients.

[Flycaster305]

I have the same diagnosis, 55% blockage of the left side, 60% on the right side.  I'm a 68 year old male.

It certainly is a concern, especially in my opinion the 69% blockage.  However, most insurance companies won't cover the expense of surgery until the blockage is 70%.  Usually blockages are catagorized in as 50-55-60% increments, not single digits.  

Even at 70% blockage, there is a lot of blood flow, so keep that in mind.  It's a wakeup call to watch the diet, restrict fats, exercise daily and certainly no smoking.  From your posting name I suspect you do those things.  I'd also certainly suggest an 81 mg aspirin and probably Plavix, of course a statin,  but talk to your doctor about that.  Have you had a stress test or a cath to determine if you have blockages in the heart?

You might want a second opinion, but certainly, I'd  exercise daily and take a statin to lower the cholesterol, watch the diet and mix in a good Omego 3 fish oil tablet.  Exercise also helps increase the HDL good cholesterol levels that are so important.  

Keep us informed, interesting post.