best treatment for stroke patient

[spinky88]

My dad is 87 years old and presented with dizziness and balance issues, including walking to the left and inability to stop.  We took him to the ER where he was diagnosed with a stroke which turned out to be a TIA. That has resolved and the doctors say it stemmed from the artery at the neck.  I think this would be the Basilar artery.  However, since they realized he was having a stroke they also did an ultrasound, three MRI's and a CT to check his carotid arteries and one is 100% blocked and one is 70% blocked.  The surgeons are giving conflicting information to us and 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 and we have been told that doing it any earlier than four to six weeks would almost certainly cause a massive because he needs healing time (even thought the TIA came from the back and not the carotids).  We are confused now because we do not know whether to push for the surgery or wait.  We have spoken to three different surgeons and have been given three 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 and what he/she would do in this instance as far as how long to wait for him to go into surgery.  If we can come up with a time frame that appears to be in his best interest, we can make arrangements to carry him to an ER by ambulance out of town but financially we just can not do that to hear, oh yes we would wait that long too and then have to try to pay for transport again when he needs to go back.  We have discussed these conflicting instructions with each surgeon but each one stands by his opinion and what is worse, each one says that it is standard procedure and 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 and not have a massive stroke waiting.  He is now on Plavix, aspirin and a medication for cholesterol if that helps in the way of information.  To any one who will answer, you have my deepest thanks.

[Paderla Anitha, DNB]

Hi, understand your predicament. But the fact is your father has had a TIA and surgery needs to be performed to prevent further episodes. According to studies done, carotid endarterectomy can be done several months after a stroke or TIA. But people benefit most from the surgery if it is done within 2 weeks of the stroke or TIA. Delaying surgery longer than 2 weeks increases the risk for stroke, because people are more likely to have a stroke in the first few days and weeks after a first stroke or a TIA.

The likelihood of complications from carotid endarterectomy varies, depending on the skill and experience of the surgeon. The American Heart Association Stroke Council recommends that surgery be done by a surgeon who has complications in less than 6% of the endarterectomy surgeries that he or she performs and that the hospital rate of complications be just as low. Hope this helped and good luck with his therapy. Regards.

[spinky88]

Thank you for your helpful and concise answer.  We are trying now to get a timely appointment to have the surgeon evaluate his current condition; and we have totally revamped his diet to restrict foods that are not heart healthy.  He is on Plavix as well.  I appreciate you taking time to answer my questions and offer your expertise.