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Carotid Artery Blockage

  My husband was just diagnosed this past week (MRI and DOBLER) with 100% blockage in left carotid artery.  He's 56 years old, nonsmoker, nondrinker, exercised daily, active.  Right carotid 40% blockage.  Instructed to take aspirin a day and placed on blood pressure medicine.  Only borderline high cholestrol up to this point in time.  Further tests and meeting with neurologist this week.We have been informed by our practioner that once the carotid is 100% blocked nothing can be done to clear that artery.  Is this true? Over time what will this 100% blockage do to the left side of his brain?  What about possibilities of a major stroke? When is surgery recommended?
Thanks for your question.  Although the MR-Angiogram and Carotid Doppler
resolution has improved very significantly over the last few years, the
"gold-standard" for the evaluation of an arterial stenosis/occlusion is
still an angiogram, because the detection threshold of the first two exams
is still not as good as that of an angiogram.  In other words, there could
still be a minuscle flow going through his left carotid.  One reason this
finding would be important is the possibility of the artery wall lesions
sending blood/tissue clots up towards the brain, if the occlusion is not
Because you did not describe any neurological impairment in your message,
I am assuming that the lesion to your husband's left carotid developed over
a relatively long period of time, thus allowing his intracranial vessels
to develop adequate collateral circulation and by-pass the diminished flow
from his left carotid.
The intracranial blood flow is normally provided by the two internal carotids
and also by the two vertebral arteries situated in the back of the neck/head.
Therefore, it is very important that the flow of his vertebral arteries
also be properly evaluated.  There is a "circle" of arterial vessels located
at the base of the brain "linking" the carotid and the vertebral artery
system called "Circle of Willis".  The blood supply to the left hemisphere
in your husband is probably being provided by collateral coming from
the right carotid and the left vertebral arteries.
Because he has already a certain degree of narrowing in his right
carotid artery, the chances of a stroke if further narrowing happens to
his right carotid is very significant.  I would strongly recommend that
your husband be evaluated a team of neurologists and neurosurgeons specialized
in cerebrovascular disease.
If you live in the Cleveland area, the Department of Neurology and Neurosurgery
have a group of neurologists (Drs. Furlan, Sila) and neurosurgeon (Dr. Chyatte)
specialized in cerebrovascular disease.
If you would like to make an appointment please call
1-216-444-5559 or 1-800-CCF-CARE.
I hope this information is helpful.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.

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