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.