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Ask the doctor: When to remove carotid blockage?

Anthony L. Komaroff, M.D.

Q. At what percentage of blockage of the carotid artery do you consider surgery? I am a 73-year-old man with a 70% blockage, and my doctor says to wait a year and check back then.

A. As you know, your carotid arteries are the main blood supply to a large part of your brain. Blockages definitely pose a threat to the brain, but there are risks to the treatments as well.

My answer would depend on many things about you that I don’t know. I’m assuming you are otherwise in good health, and that top-flight surgeons who perform lots of carotid surgery are available in your area.

If that’s the case, then the most important question is whether you have had any symptoms from your carotid blockage—a mini-stroke (called a transient ischemic attack, or TIA), or a full stroke. If you have, and you have a 70% blockage in the artery that caused the mini-stroke or stroke, then I would think it’s generally wiser to have the surgery rather than to wait a year. If you have not had any symptoms, many doctors still might recommend surgery, but waiting might be justified.

Surgery is not the only option for people with carotid artery blockage. Angioplasty and stent placement is an alternative, and so are blood-thinning medicines. But particularly if you have had symptoms from your carotid blockage, surgery is associated with the best long-term outcomes.

In summary, if you’ve had symptoms already from the blocked artery, just waiting a year without any of these three types of treatment would generally not be wise in my opinion.

—Anthony L. Komaroff, M.D.
Editor in Chief
Harvard Health Letter

Posted by: Dr.Health

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