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Seeking Urgent Advice on Carotid Stenting
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nnchokshi posted:
Hello

My mother has had a bit of history recently regarding stroke and has been advised to go for carotid stenting on an urgent basis. I am seeking advice whether we should consider this or not based on the description below.

In June'12 she started having some dizziness and fell down couple of times. The doctors diagnosed that her right carotid artery had stenosis of 90-99% and left of 75%. The doctor tried putting a carotid stent but did not succeed as the artery route was torturous. Subsequently, she started showing some TIA symptoms within couple of days and was admitted to have Carotid Endarterectomy done using Dacron Patch. This option lasted 10 days when a Carotid Blowout occurred due to a problem with the patch itself or poor quality of stitures. She was admitted again in emergency and an another doctor tried repairing the patch via re-stitching. This lasted for another 5 days before a further blowout occurred at the same place. This time the doctor removed the patch and that part of artery and placed a PTFE graft instead. This operation took about 18mins to complete. As a result, she suffered from a stroke and developed hemiplegia on left arm/leg with no voice/swallowing symptoms. The symptoms all recovered over a period of two months when she almost recovered completely back to normal.

On 2nd Nov, she had a stroke on the same side, resulting in hemiplegia of left arm/legagain. This time she did not lose voice or swallowing as such.

On doing Doppler ultrasound, the doctors found that her right artery has developed 100% occlusion (at the origin of the artery) and that the stenosis on the left side has grown to 80 to 90%. This was confirmed subsequently via a CT Angiograph.

The doctors are now suggesting that we should forget the right side and concentrate on left side. They are advising us to go for Carotid Stenting on urgent basis (i.e. within 6 weeks of the stroke).

I am bit concerned that if the first diagnosis in June was not correct (she did not have TIA symptoms until the first stenting was done) then whether the current diagnosis is accurate or not.

I am seeking advice on:

1. how accurate can be the diagnosis from Doppler Ultrasound or CT Angiography in terms of detecting the percentage of blockage they are reporting.

2. What is the risk of stroke on the left side if she is currently asymptomatic on that side (right side was symptomatic only after the first attempt of stenting).

3. What is more advisable - drug therapy, stenting or endarterectomy. She is 71 years old, diabetic and asthamtic for last 20 years and has the history of hypertension (bypass surgery done in 2003)

4. What might be the cause for this recent stroke on right side - can restenosis occur in PTFE graft or that artery within 4-5 months of surgery? If the stroke is due to thromboembolic reasons, then are there any options (invasive/noninvasive) to open up the blood flow? Could that occur naturally over a period of time?

5. Any suggestions of the best surgeons/practitioners who might be willing to give volunteery advice on the above if I provide copy of all medical reports via email/net.

I look forward to your kind and expert advice on the above.

Regards

Nirav Chokshi
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nnchokshi responded:
Hello all,

I wonder if anyone can give me advice on the question below - we are reaching to that point where we need to make a decision either way and any advice on this would really help.

Apologies for the length of the question

Regards

Nirav Chokshi


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