i have been told i need an operation on my carotid artery since i have a blockage of 95% on the right side. I have been reading on it but still afread of complications. thanks Mike here ya go
http://www.neuroland.com/cvd/cea.htm
Joint Study of Extracranial Arterial Occlusion 1969: 50 patients with severe strokes: treated with CEA < 2 weeks: 34% improved, mortality was 42%.
CEA > 2 weeks after stroke in 18 patients: improvement in 72%, mortality rate 17%
187 patients treated nonoperatively: 53% improvement and 20% mortality
Generally accepted therapy for carotid stenosis after infarction: a delayed endarterectomy 4 to 6 weeks after the event.
Giordano et al in 1985: 49 CEA performed on patients with neurologic deficits > 24 hours: Postoperative strokes occurred in 18.5% of 27 patients operated within 5 weeks, and no strokes occurred in 22 patients who received surgery after 5 weeks.
Whittemore et al: 28 patients with "small fixed neurologic deficits," 15 received CEA for stenosis > 75% within 1 week without neurologic complications.
In a subset analysis of NASCET reported by Gasecki et al, 100 patients with a "nondisabling" stroke with carotid stenosis of 70% to 99% received endarterectomy from 3 to 30 days after stroke, with a stroke rate of 4.8%.
To identify lower-risk candidates for early CEA with acute neurologic deficits: CT scans at 1 and 5 days after presentation. Dosick et al: excellent results by stratifying patients based on the presence of infarction on CT. Negative CT: CEA at 5 -14 days
Positive scans: CEA delayed to 4 - 6 weeks
Other reports have not supported the use of CT scans to define a subset of patients that may safely undergo early CEA.
Patients with less ischemic damage, by clinical presentation or CT scan, may have less postoperative hemorrhagic conversion. Other theories: improve control of perioperative anticoagulation and hypertension.
Evaluating the use of anticoagulants in the treatment of stroke, Ramirez-Lassepas and Quinones found intracranial hemorrhage to occur with embolic stroke, large cerebral infarcts, markedly elevated blood pressure, excessive anticoagulation, and heparin induced thrombocytopenia.
Risk of waiting before surgery. Dosick and colleagues: Incidence of recurrent stroke during this waiting period 9.5%.
The incidence of recurrent neurologic symptoms within 1 month in the VA Cooperative Studies with carotid stenosis greater than 50% was 6%. Please see the webpages for more details on Carotid artery surgery and Carotid endarterectomy. I have cared for many patients who have had this done. All surgery comes with risks but if you have 95% blockage your risk of a stroke is much higher if you don't have the surgery than of having a clot form after surgery. You would be given medication to reduce your risk of clots forming after your surgery. If you are in otherwise good health this is a simple operation performed on many many people. Think of the complications you will have if you dont have it. You really dont have a choice. Better go to the cardiovascular surgereon and get it over with. The sooner the better. I cannot believe he is letting you sit on this. If you dont get on it, you will piss around and have a stroke because you are worrying your little head off. You will do fine.
Make sure your cardiovascular surgeon comes with good credentials......like your not the 1st one he has ever done. He will tell you what the risks are, but you have to do it anyway so it makes not difference.
I had some heart procedures done in October and prayed a lot. I got my affairs in order and cleared my heart with God and went for it. You better do the same.
PS: I did an internship in Critical care, and the recovery time is fast and none of the pts had problems. They had one big surgical incision up the side of their neck an art line which is more for convenience in surgery and out of CCU in 1 day and home in 3 days start to finish. I am also a nurse. A lot of patients with heart blockages also have blocked carotids. It is always preferred to perform the carotid endarterectomy first because of the risk of strokes. It is vital to make sure your brain is getting enough oxygen via blood circulation.
As a general rule in medicine - everything has a risk - the risk of complications having the procedure done vs the risk of problems if not doing it. Every choice - from taking a pain pill to major surgery must be weighed before deciding the appropriate action. Yes, there are potential complications, but the procedure has been around a long time and has a great track record of success.
I have cared for such patients, but also have had two relatives who have had the surgery. They both did very well, recovery was very quick, and they have had a much better quality of life afterwards. With 95% blockage, you really don't have much choice.
Good luck to you. | 