Advice about possible surgery on coradit artery

[jerziguy1975]

My father (age 62) is currently in the hospital (May 8, 2007) after having one of the latest in the line of TIA's, and then a stroke. Over the past 3 or so years he has had a handful of them which have left his motor and mental abilities slightly slower than they used to be. I should also mention he has been diagnosed last year with Parkinsons Disease. My question or advice I would like to ask relates to this recent stay in the hospital. I would appreciate feedback from anyone that might have had a similar situation or know of someone that might have went through the same set of circumstances.

As things stand now, my mother and I have learned that his left coradit artery is about 80% blocked. He is also having numerous blockages throughout his basel ganglia. He will be leaving the hospital tomorrow, and transfer to a rehab center for about a month. The decision we are left with then after that month is for him to go in for surgery on the coradit artery. We have been told by the doctors that if that is done it will prevent a stroke from taking place there. On the other hand they have said that it probably wouldnt do any good for the basel ganglia. That the surgery most likely wouldn't relieve any trouble there, and that a stroke could develop there at any time. There is also a possibility that the coradit artery surgery could even cause a stroke in the process.

So that leaves us with the catch 22 as to what direction to take. If anyone has had or knows of a situation like this your advice would be greatly appreciated.

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
     The questions you have raised are good ones.  Your father is relatively young and a large vessel stroke can leave him permanently disabled (such as, unable to talk or move one side of his body).  There are 4 large vessels that go to the brain, in the front are the 2 carotids (left and right) and in the back there are 2 verterbral arteries.  If one these vessels is completely blocked off, it can cause a large devastating stroke.  Patients with high blood pressure are also a risk for a different type of stroke (called a lacunar stroke) and this involves tiny arteries that feed a deep structure in the brain called the basal ganglia (helps control movements and does not function well in parkinsons disease).  These lacunar strokes are smaller and often cause less damage.  When the carotid arteries begin to fill up the atherosclerosis (hardening of the arteries) they may close up all of a sudden (called a ruptured plaque) and cuase a stroke.  That is why, it is often wise to have a tight carotid stenosis repaired either by surgery (carotid endarterectomy-CEA) or by carotid stenting.  At a center that does these procedures routinely the risk of a stroke during the procedure is much less than the risk of a stroke if nothing is done.
I hope this has been helpful.

[DungeonWitch]

I just read your post. I am in a situation in regards to whether or not to even have my Mom's caraotid artery checked. She is 80, has Alzheimer's and has had TIA's. Someone stated, "If she is blocked, do you really want her to have surgery?" She is in a fairly ok place in the AD disease, but in a dementia unit, and I am still having a horrible time coming to terms with the loss of the Mother I once new. I HATE this disease. I only cared for her in my home for a little more than a year, but it seemed like pure hell. I just felt so bad for her!
I totally understand your feelings in regards to how you feel with the anger and with the "silent wish" he slips away. It is just plain cruel for anyone to live a life like that and for you to suffer along with him. I am saying a prayer for you and your Dad.

[laaz]

my 83 yr. old father was told he needed cartoid arthery surgery. Doctor said less than one percent of having a stroke from the surgery. If my dad did not have the surgery- he would probably have a stroke within a year.  So my dad had the surgery and had a stroke on the operating room table.  Can not walk, talk, has a cathater for urine. Eats pureed food, thickened liquids. Can not wipe his own butt.  He use to be very active, drive, go out for breakfast every morning since my mother had died. Lived be himself, went to get groceries etc. I quit my job and he has moved in with me and my husband. He needs 24 hour care.  I wish to god that he NEVER had that damn surgery. He is not living he is just existing. Having the surgery he thought would keep him alive longer and prevent a stroke - now look at him. NO LIFE I would greatly think twice before having any surgery, you just never know what could happen. My dad has aspirated on food 6 times in a little over 2 yrs. since the stroke. I just pray that he dies in his sleep. and end this terrible nightmare.

[Quixotic1]

You are truly in a "Catch-22."  I am facing a similar problem with my mother -without the complication of basilar artery obstruction and PD.  She is 83 and totally with it.  She adamantly refuses to have any more surgery, due to prior difficulty coming out of anesthesia.  She also is terrified of being left alive after a major stroke.  She has major obstruction of one of her carotid arteries.

I would use my not inconsiderable influence (as a physician) to talk her into surgery, but a good friend of mine just went through this with her mom.  She convinced her mother to have the surgery, and her mom died from a stroke on the operating table.  She is devastated.

I say this not to terrify you, but to commiserate with the dilemma.  I'm not sure there is a perfect solution, though I suspect in the hands of a very good vascular surgeon the odds are much better in favor of a good result.  Again, this is aside from the problem with the basilar artery, which I don't know much about.

My mom's new cardiologist, which I very much like and trust, has suggested a stent, placed non-invasively through a large artery (probably the femoral). A stent is like a tube whcih is place in the area of obstruction to keep the artery open.  My mother is receptive to the idea, and we will be seeing him again soon.

Is your father competent mentally?  Can he participate in the discussion?  I would seek some opinions from good cardiologists, have another opinion from a vascular surgeon, and see if you can talk it through with appropriate family members.  My heart truly goes out to you.  Our strongest impulse in times like this is to DO something.  It's hard to just sit and know about a possible time bomb.

I'll be thinking about you and your father, best wishes, Quix