Carotid Arteries

[r-Tashjian]

    
      Re: Carotid Arteries
    


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Posted by CCF NEUROSURGERY MD on October 09, 1997 at 09:25:37:

In Reply to: Carotid Arteries posted by r. Tashjian on October 02, 1997 at 10:25:20:

: In a nutshell--48 yr. old mail with diabetes and neuropathy recently suffered a small
  stroke, resulting Doppler showed excessive blockage in both carotid arteries.
  However, 3 yrs ago had quadruple coronary by-pass during which nearly died
  due to ARDS.  Recovered but neuropathy in legs worsened, put on morphine patch
  several cholesterol medicines in addition to insulin, etc.  Subsequent pain
  found blockage in legs in addition to neuropathy.  Stent placement tried
  several times--never succeeded.  Several leg by-passes later, it is found
  that the by-passed arteries have blocked yet again in three months time.
  Cholesterol is under control with two medications and diabetes is not that
  extreme.  No one can offer an explanation for why he keeps clogging and now
  the carotid issue.  Will undergo an MRA and then surgery on the carotid
  arteries.  This is a risk, obviously.  Insurance will not allow for second
  opinion at Cleveland Clinic.  At his age, what could be the cause for this
  excessive blocking and how will these carotid arteries not block again like
  the legs did.  How many times can someone undergo surgery of this sort?
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Dear r Tashjian,
The general term for the disease you are speaking of is atherosclerosis.
Atherosclerosis is 'hardening' of the arteries and narrowing from cholesterol
deposits in the vessel.  Atherosclerosis generally increases over time.  It
a systemic process that has effects in blood vessels of the heart, legs,
carotid vessels (causing strokes) to name a few.  The risk of having problems
from atherosclerosis is increased with a history of diabetes, hypertension,
smoking and high cholesterol.
Your particular situation is a familiar one to the vascular and cardiovascular
surgeon.  Atherosclerosis affects all the areas mentioned, and you have had
surgery on the heart and leg vessels.  The fact that you have clotted your
leg vessels shouldn't increase your risk of danger with carotid surgery.  
This is assuming you do not have any underlying clotting disorders.  
You are,however, at increased risk for surgery due to your previous history
of heart problems, diabetes and ARDS.  You and your surgeon must weigh this
risk against the risk of having more and possibly devastating strokes.  
Many physicians will find that carotid surgery is still warranted, and there
are studies to support this.
To minimize your present and future risk of problems such as this, there are
a few things you can do.  Tight control of blood sugar, management of hypertension,
lowering cholesterol, quitting smoking and a sensible diet combined with a
fitness regimen are key issues in these cases.  It must be understood that
for these changes to be effective, they need to be incorporated into a lifestyle.  
To make these changes for a month or to will do no good in the long run.
You should discuss these issues with your physician and surgeon in terms of
risks of surgery and minimizing your risks in the long run.  The lifestyle
changes are difficult, but you have already seen the adverse effects of
atherosclerosis.
Good luck.