COROTID ENDARTERECTOMY

[chapo]

Hello, my father is a 74 yo. with evolving vascular dimentia (dementia) with loss of cognitive ability and mobility. His medical history is: Hypertension last 22 years under control.
AMI. 1992, Right CVA 1992, good rehab.  DVT 1994, Left CVA 2000, followed by UAP in hospital with multiple cardiac arrest. Cardioverted with shocks and Amioderone.
C.A.B.G.'s x 4 followed.  CT scan showed, multiple past right parietal infarcts, peri-ventricular iscaemia, and cerebrovascular disease in the deep white matter. A peri-ventricular hypodensity was located from this CVA.  
Corotid doppler located an occluded left corotid with plaque seen just past the origin.
He went well for  a time but is now deteriorating.
Q Is endarterectomy indicated and what are the risk/benifits outcomes likely to be with this history.
Thanks
chapo

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

Unfortunately, once a carotid is occluded (meaning completely blocked) you cannot do surgery. You can only consider the endarterectomy when the artery is narrowed. The landmark research trial by Dr. Henry Barnett showed benefit for patients who had 70% or greater narrowing of the carotid artery with symptoms localizing to that side to have surgery rather than medical management alone. The benefit is overall stroke rate and death. The risks of surgery are bleeding in the brain, stroke, infection, and not uncommonly mild facial weakness.

Sorry to hear about your father's overall decline. I can understand how you are looking for anything to potentially make him better. Vascular dementia however will not get better with surgical intervention. What you can do to stablize him is control his blood pressure, cholesterol and other stroke/heart risk factors and maintain a secure and familiar environment for him where there's family, friends or excellent nursing staff to care for him. Good luck.

[Serger]

I am a 53 yo female.  Had total hip replacement in March 2001.  Then in June had one lapse of consciousness.  Have multiple brain lesions thought to be MS, diagnosed in 12/96.  Following lapse - 2 weeks later - experienced 6 hours of total blindness in right eye, then another day same amount of total paralysis on right side of body. Had to use walker since swaying motion was not safe.  Resting on bed felt as if could not breath.  Called 911 taken to hospital for 9 days.  Every test in world done.  Thought it was system closing down because of MS - hence gallons of steroids to arrest inflammation - this was a guess!  MRI showed cycst in brain (new) also  occluded right carotid artery, partial left 16%.  Was given Phenytoin and Topamax since doctors believed seizure was cause of lapse.  Returned to hospital twice beginning and end of October with toxic amounts of Phenytoin - between 28 and 32!  This drug was killing me, making me mad, crazy behaviour and hateful.  Felt as if I was going to die, skin looked like it too, I also felt so vulnerable to everything.  Neuro decided to quit phenytoin and it has taken toll on body with liver, kidney damage.  Has taken 3 months to rid it from my system. Dr in hospital wanted to clean out right artery, went for second opinion.  Had angiogram and felt as if head was going to explode.  New vascular dr. thought he could do surgery since string width may still be open.  Transpired that surgery too dangerous so have gone for medical route rather than surgery with Plavix and other meds.  Now I feel so much better, look healthy, rarely use a cane to walk, and walk five times a week for about 2 miles each.  Have never had blood pressure problem but am using 750mg sodium and 200 mg cholesterol as my personal maximums per day to help my body.  Very difficult at first then as I got better I became more inventive.  Have lso found out I inherited Factor IV Leiden Disease from father and have low Protein S which means I have fatty liver and lipid disease.  Took Avonex for MS from March 97 until side effects in June 2001 became so severe stopped using it.  Have not had any MS symptoms since, which were literally a daily occurrence.  Naturaly I am still little fatigued because of all that has happened to body in last year.  Could brain lesions and new cyst actually be neurological lipid disorder?  Since I have started this later in life and am effectively taking care of it mean that the onset will be really slow, if at all, if this is the case?

[squirrely]

what are the symtoms of MS?

[Serger]

Response to ? about MS.No two people with MS have the same ailments.  The biggest thing is fatigue - absolute and total, you have to give in.Often you find eye interference or Bell's Palsy starts the beginning of it.  Searing head pain (not headaches nor migraines) I have always called them "spikes" literally like someone is stabbing a part of your head with a spike - other times it feels ike it comes from inside your head.  Generally your immune system overreacts to everything; other people have a cold and get rid of it in 4 days, you take 10 and still feel awful.  Weakness and spasticity - you never (rarely) know when it is going to happen - you just fall down, arms and legs may be flailing - could be mistaken for being drunk.  Occasionally you get an "aura" similar to migraine that warns that this is about to happen and you must sit or lay down to avoid hurting yourself.  It is very unnerving (sorry about the pun) because it creates loss of confidence.  Anothr thing it often interferes with bladder (retention and leaks) and bowel.  Muscle aches and pains appear from nowhere, arthritis gets worse.  Because the cover (myelin) on the nerve that sends messages to your body is worn away the messages get muddled, so your actions (physical) can also be confusing to you.  Cognition is another horrible problem because often you know what you want to say but it is not what actually comes out of your mouth and it is quite likely people will laugh at your or not understand you at all - bit like every other word is blipped out.  Often it is indescribably hard to read instructions for something - you read each word but your brain just cannot get the information together as a whole.However, having sai this it is quite easy to read a novel and I have got through libraries of books.  Very contrary  This is terribly frustrating, but you need not always be like this.  Symptoms (for me) varied from day to day, but they were every day.  It takes away a regular social life, sex life, family activities and you always have to expect not be to able to attend something you desperately want to do - this is hard for those around you to understand too.  Other people have expectations of you that it is often impossible for you to meet, but don't just think you will be OK and that it will pass.  It is very hard for your children to understand why one day you can be cooking, sewing andhappy, then the next asleep in bed for 16 hours or more.  The pain that appears from nowhere is probably equal to the fatigue and a total mystery.  If you think you have it you need to have an MRI done and read by a "competent" neurologist - spinal taps are not necessarily accurate.  You will find the amount of medications you take increases, including anti depressants.  Please seek professional help.

[troyetta]

I am a 33 year old female, I've had migranes that have gotten worse the last year now they are almost daily, along with that i started having seizures. i recently found out my right car. artery was completely blocked and that there is nothing they can do.so my headaches are getting worse every day i go to sleep with out a headache and i wake up with a headache. now they say i might have fluid on my brain,... if anyone knows anyone that can help me please let me no right now they have me on perciocets. all the help would be appriciated

[peach4844]

Has anyone ever heard of the novicaine shot that was used to do this procedure go directly to the brain, causing seizures and the like?  This happened yesterday to my aunt, and she is now going back into do the surgery today.  

My main question is, how rare or common is this??  Could it have been as the result of the anesthegiologist missing something and putting the novicaine directly into her cartoid artery?

Thank you for any help!!

[chapo]

I posted the original question here about the Endarterectomy.
I need to here from anyone who has had this operation, in the setting of having one Carotid Artery completely blocked and the other 50% narrowed. Any advice appreciated.