carotid artery surgery or status quo

Posted By  CCF CARDIO MDsc on February 18, 1998 at 08:48:27:

In Reply to: carotid artery surgery or status quo posted by Gordon on February 08, 1998 at 18:11:00:

: I'm 77, 6'4" 200 lbs. History of heart problems: damage to left rear heart
  diagnosed age 62; arrythmia starting age 73 controlled with medicine. In December
  doctor recommended carotid artery surgery feeling left artery was 70% occluded.
  A preliminary angioplasty was done during which I had a stroke which damaged the occipital lobe and caused
  hemianokpsia. I lost peripheral vision in right eye with some loss of corner vision in
  left eye--no improvement so far. The angioplasty showed the vein was 60% blocked
  but had some ulcerated plaque. The surgeon still recommends surgery while the internist
  is against surgery. I don't know what to do. Thank you.
   Medications: Covera HS 180mg 1 tab daily Lanoxin .25 mg 1 tab daily
   Toprol-XL 100mg 1 tab daily Coumidin .5 1 day/.25 3 days  
  

[CCF Cardio MD sc]

_ L-thyroxin/Levoxyl .1mg 1 tab daily
  Dear  Gordon.
Before I get into answering your question I would like to recommend that you also post this question in the neurology section so that you can get their perspective on your problem. The latest recommendations are   carotid end artrectomy,  as the carotid bypass surgery is referred to should be offered to patients with stenosis in the carotid artery of 70% more. In your case although there are different values of 60% and 70%, the fact that the angiographic view revealed an ulcerated plaque and the fact that the procedure was complicated by a stroke shifts the balance towards recommending the surgery. Unfortunately this will not reverse any permanent damage that has already been sustained but will hopefully prevent further neurologic insults from occurring.
Again I recommend that you resubmit this question to the neurology forum as this is more in their realm and that will have a greater experience in this field. One thing I would like to recommend is that if in actual fact surgery is to be performed it is important that a full cardiac evaluation is performed before your surgery in lieu of your cardiac history.
I hope we this will help in guiding you as to what option you should undertake, if you have any further questions or would like to be seen by one of our cardiologists at the Cleveland Clinic please feel free to call 1-800-CCF-CARE to set this up.
Information in this forum is intended for general purposes only, specific diagnosis and treatment strategies should be reserved for physicians directly involved in patient care .