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Carotid Artery Blockage - Vascular Surgery?

Thursday, November 2nd, 2006
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My husband recently had an MRI on his neck. His primary care physician told him he has a 100% blockage on the left side in his carotid artery. The right side is fine. He then made an appointment for him to see a vascular doctor in February of 2007. I’m worried about the appointment being so far out. My husband has diabetes and he also has a blockage in one in of his legs and has had stints put in arteries to his heart. Isn’t this a serious situation for mu husband? Thank You Miss Dottie

Dr. Joshua’s Answer:

Generally speaking, a greater than 50% carotid occlusion is considered for vascular surgery (carotid endarterectomy). The timing of surgery or whether surgery is indeed needed will depend on many factors, most importantly the clinical symptoms. A history and a physical examination will reveal whether there is reason to believe the occlusion is causing symptoms, such as stroke or transient ischemic attacks (TIA, temporary stroke symptoms), in which the blood flow to the brain is disturbed.

In your husband’s case, one carotid artery is completely occluded. If he has no symptoms of stroke or TIA, this means that his circulation has adapted to the situation and his brain is getting sufficient blood flow from the other 3 main arteries bringing blood to the brain. The arteries are all interconnected in what is called the Circle of Willis, which is a sort of a back-up system for brain circulation. In you husband’s case, the Circle of Willis is doing its job right.
In such a situation, surgery is often not recommended for the occluded artery. However, it is of paramount importance that his right carotid artery stays in business. He cannot afford to lose another artery. For this reason, a prompt consultation with a vascular surgeon is indeed essential.

Unfortunately I cannot comment on the date of the appointment as I do not have enough information at my disposal, and I’m not an expert on vascular surgery. You’ll need to express your concerns to the referring physician.

Meanwhile, it is advisable to take all possible measures to keep the other arteries healthy. Smoking is absolutely forbidden. A healthy diet and moderate exercise is recommended. A review of the blood lipid levels and possible need for cholesterol lowering medication and/or antithrombotic/anticoagulant (Aspirin, Warfarin) with your primary care doctor is advised.

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