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Stroke care

Stroke care

Hello My father lives in a semi rural part of Australia and I have had some concerns about his health care.
In 1992 he had an AMI and stroke around same time. routine CT scan showed cerebrovascular diseas in the deep white matter.
In 1994 he had DVT so was put on Warfarin.  In 1999 he had an episode where he could not speak properly for a few seconds and was confused. We took him to the local hospital and the Doctor said  he had a TIA and as he was on Warfarin there was nothing more to be done. He was allowed to go home with no follow up.
In 2000 he had a fairly severe stroke and had a CT scan the following day to rule out heamorhage. None found. A year later he had a MRI and Cartoid duplex. Showing Occluded left Carotid and reversed left Vertabral artery due to left subclavian stenosis.
His recovery has been poor and he cannot walk more than a few yards and has few activities.
My questions are:
1)Why cant a Carotid Endarterectomy be done post occlussion.
2) Does it sound like his care was lacking, particularly in the tia in 1999. I cant understand why he was not considered for a cea or subclavian surgery from the start. Now his doctors say its too late for any surgery. Thanks
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Carotid endarterectomy typically is not performed after an occlusion for many reasons. First, opening up an occluded artery can result is a brain hemorrhage after the surgery. Second, once a artery is occluded the damage to the brain is usually permenant. If a patient is still having new symptoms in the distribution of the occlusion, then a bypass  may be considered. Rgarding the events that occurred in 1999, I am unbale to offer an opinion. I hope he continues to approve with therapy.
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