need help with time frame for surgery

[spinky88]

My dad is 87 years old & presented with dizziness, balance issues, & walking to the left w/inability to stop. In the ER he was diagnosed w/a stroke which turned out to be a TIA. That resolved & the doctors say it stemmed from the artery at the neck, the Basilar artery?  Realizing he had a stroke they did an ultrasound, 3 MRI's & a CT to check his carotid arteries. One is 100% blocked & one is 70% blocked.  The surgeons are giving conflicting information to us so I am hoping to get some input from a surgeon here.  We have been told the surgery to unblock the arteries needs to be done within two weeks for the best chance to prevent a massive stroke & we have been told that doing it any earlier than four-six weeks would almost certainly cause a massive because he needs healing time (even thought the TIA came from the back & not the carotids).  We are confused now because we do not know whether to push for the surgery or wait.  We have spoken to 3 different surgeons & have been given 3 different time frames as one pushed it out to eight weeks.  We live in a small town so we do not have access to any sort of teaching hospital without a long trip that my dad is not really able to make right now. PLEASE will someone answer my question with their opinion, or the time frame they use for surgery in these instances.  We just feel like we need input from a surgeon who is just reading the facts & what he/she would do in this instance as far as how long to wait for him to go into surgery. We have discussed these conflicting instructions with each surgeon but each one stands by his opinion and worse, each one says that it is standard procedure & any surgeon in the country would perform the surgery within their time frame.  We just want our dad to live and to have the best chance for successful surgery & not have a massive stroke waiting.  He is now on Plavix, aspirin & a medication for cholesterol.  To any one who will answer, you have my deepest thanks.

[spinky88]

Thank you so much for your answer.  It is very confusing when you are getting conflicting answers and you do not have the knowledge to discern which advice to follow.  He has amazed us with his willingness to change his diet, especially since they have restricted him so drastically.  In essence, the docs took away every food he loves, which is why he developed the problem in the first place, by eating the wrong foods.  Thankfully, other than some weakness and tiring easily, he appears to have no lasting effects from this episode.  He is taking his blood pressure twice a day, and taking his aspirin and now Plavix.  He is going for a follow up MRI tomorrow and sees a Thorasic surgeon in about two weeks now. It is very comforting to know that as a cardiac specialist, you agree that he is following a time frame that you agree with in waiting to have that evaluation.  Of course, at his age, we are concerned about him having surgery at all and they did say that they doubted the surgeon would touch the 100% side.  It is helps a lot to hear you confirm some of the information we have received.  We have been on pins and needles trying to decipher the differing opinions and trying to make decisions that are in his best interest.  Thank you so much for confirming that the plan that is currently in place is an acceptable time frame and putting us a bit at ease that we are following what now seems to be protocol in a situation likes his.  I am so grateful for your input.  You seem to be a very compassionate and knowledgeable physician...too bad you are not near where we live!  He does also have an appointment with the neurologist, so I guess we are on track with what needs to be done. Again, thank you so very much for taking time to answer and helping us as we try to gain the best care for my Dad.

[CCFHeartMD 26]

Sounds like you guys have had a frustrating time.  I am a cardiologist, not a surgeon, but we often deal with the same situation (cardiologist also do stenting for carotid artery blockages so we often see similar situations as your family members').  It is really difficult to give you an accurate assessment/plan with limited information, but if it was truly just a TIA, then the risk of a "massive stroke" intraoperatively is no greater now that it would be in several weeks.  If he had a stroke that was caused by embolization (traveling of plaque from the carotids to the brain), then waiting for a period of several weeks at least is the safest thing to do as the risk of him developing a life threatening, bleeding stroke in the brain (from his old stroke site in the brain where those cells have died and scar is forming) intra or postoperatively would not be small.  For the 100% blocked carotid artery, you would not typically bypass or open that area up as the body normally develops collateral channels of blood flow around the blockage through formation of new blood vessels (isn't the body smart!).  Typically, once a patient has developed symptomatic carotid artery disease or other arterial disease leading to TIAs/strokes, operating or stenting as soon as it is safe to do so is really important.  In the meantime, continue to work with your surgeons/neurologist and continue the medical regimen he is on; hopefully you will have a plan soon for intervention as soon as it is safe for him.