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Does Carotid Artery Blockage In An Elderly Person Result In A Stroke?
Question: Hello. My 90 year old stepfather just had a small stroke temporarily affecting his speech, attributed to 80% blockage in the carotid artery, possibly due to the effects of radiation 10 years ago for salivary gland cancer.
The stroke did not affect speech or movement and a stent will be inserted on Monday. What might be the risks associated with the procedure itself, and related future complications??
His other tests are apparently normal, and he is in good health for his age I spoke to him now, and he's tired but is otherwise OK.. Thank you.
The stroke did not affect speech or movement and a stent will be inserted on Monday. What might be the risks associated with the procedure itself, and related future complications??
His other tests are apparently normal, and he is in good health for his age I spoke to him now, and he's tired but is otherwise OK.. Thank you.
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
The risks related to the procedure can be several. Most of them are very rare. The one most common risk is actually the procedure itself causing a stroke, due to the catheter damaging vessel walls. In older patients that risk is somewhat higher due to blood vessels in the elderly having more extensive changes of blood vessels. The risk depends also on the physician performing the procedure, risk is lower if done in a major center with a lot of experience (less than 3%), compared to small centers which do only a procedure once in a while.
Myocardial infarction is a less common complication in less than 1% of patients.
Other rarer short term complications would include vessel damage like dissection or perforation, hemorrhagic stroke, thrombosis of the stent etc.
In the long term a possible complication might be restenosis (narrowing) of the stent.
So there are some risks involved, but if in the hands of an experienced physician the risk is low.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
The risks related to the procedure can be several. Most of them are very rare. The one most common risk is actually the procedure itself causing a stroke, due to the catheter damaging vessel walls. In older patients that risk is somewhat higher due to blood vessels in the elderly having more extensive changes of blood vessels. The risk depends also on the physician performing the procedure, risk is lower if done in a major center with a lot of experience (less than 3%), compared to small centers which do only a procedure once in a while.
Myocardial infarction is a less common complication in less than 1% of patients.
Other rarer short term complications would include vessel damage like dissection or perforation, hemorrhagic stroke, thrombosis of the stent etc.
In the long term a possible complication might be restenosis (narrowing) of the stent.
So there are some risks involved, but if in the hands of an experienced physician the risk is low.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much Dr. Taka. The doctor said it was a miracle that his speech is normal.
One concern was that the radiation for the salivary cancer weakened or narrowed the quality of the carotid, resulting in the 80-85% blockage. But they will do the procedure from the groin, but are concerned about the quality of the carotid because of the previous radiation. Then they would want to do surgery instead, with blood thinners and rest. However he is in a good hospital. How would you view this situation?
One concern was that the radiation for the salivary cancer weakened or narrowed the quality of the carotid, resulting in the 80-85% blockage. But they will do the procedure from the groin, but are concerned about the quality of the carotid because of the previous radiation. Then they would want to do surgery instead, with blood thinners and rest. However he is in a good hospital. How would you view this situation?
Brief Answer:
Read below
Detailed Answer:
Thank you for the additional information.
In terms of whether there is an indication for a procedure, there is. A stenosis of over 70% which has caused symptoms (stroke) does carry an indication for intervention, the risk of another stroke from happening is higher then the risk of the procedure.
As for the choice of the procedure that is not always that straightforward. Both surgery and stenting are used. Stenting is always done from the groin. Generally speaking surgery has the upper hand on stenting, most studies have shown it to be superior. However with technology and stents always evolving, stenting is catching up. So there is not a major difference between the two. Decision is based on many factors such as risks of anesthesia and surgery, blockage type and length, condition of the surrounding tissue and the vessels. In our clinic it is done after common meetings between neurosurgeons (or vascular surgeons) and neuroradiologists who evaluate the imaging, narrowing length, vessel wall characteristics etc. So it is hard to express an opinion with the present information, the (tough) decision should be left to the treating physician really.
Let me know if I can further assist you.
Read below
Detailed Answer:
Thank you for the additional information.
In terms of whether there is an indication for a procedure, there is. A stenosis of over 70% which has caused symptoms (stroke) does carry an indication for intervention, the risk of another stroke from happening is higher then the risk of the procedure.
As for the choice of the procedure that is not always that straightforward. Both surgery and stenting are used. Stenting is always done from the groin. Generally speaking surgery has the upper hand on stenting, most studies have shown it to be superior. However with technology and stents always evolving, stenting is catching up. So there is not a major difference between the two. Decision is based on many factors such as risks of anesthesia and surgery, blockage type and length, condition of the surrounding tissue and the vessels. In our clinic it is done after common meetings between neurosurgeons (or vascular surgeons) and neuroradiologists who evaluate the imaging, narrowing length, vessel wall characteristics etc. So it is hard to express an opinion with the present information, the (tough) decision should be left to the treating physician really.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again. I suppose that in the case of an otherwise healthy 90 year old (with milld dementia) having had the radiation (after gland removal) for the salivary gland cancer it might be more difficult. How "harmful" is that type of radiation on the carotid artery under such circumstances?
Brief Answer:
Read below.
Detailed Answer:
I am not sure what you mean by how harmful, it is not something which can be quantified, it depends on many factors. Some patients might develop stenosis anyway, it is a common condition in the elderly, the radiation increases that risk by inciting changes in vessel walls. Factors which influence the risk are radiation dose received, patient age, time since the procedure, smoking, history of diabetes, high blood pressure, high cholesterol etc.
If it is numbers you are looking for, carotid stenosis has been found in 78.9% of irradiated patients compared to 21.6% in control group and a severe stenosis in 30% of irradiated patients compared to 5.6% in non irradiated control groups.
I hope to have been of help.
Read below.
Detailed Answer:
I am not sure what you mean by how harmful, it is not something which can be quantified, it depends on many factors. Some patients might develop stenosis anyway, it is a common condition in the elderly, the radiation increases that risk by inciting changes in vessel walls. Factors which influence the risk are radiation dose received, patient age, time since the procedure, smoking, history of diabetes, high blood pressure, high cholesterol etc.
If it is numbers you are looking for, carotid stenosis has been found in 78.9% of irradiated patients compared to 21.6% in control group and a severe stenosis in 30% of irradiated patients compared to 5.6% in non irradiated control groups.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Is it unusual that the physicians would have ignored these matters when administering radiation, or providing an ongoing treatment protocol?? Thanks.Thankfully my stepfather does not have diabetes or high cholesterol of high blood pressure or smoking in 50 years. Maybe his carotid is not as damaged as one would expect from the radiation of 10 years ago. Plus he was considered "lucky" about the damage to speech areas of the brain, that it does not seem to have affected him.
Brief Answer:
Read below
Detailed Answer:
Hello again!
Since he was being treated for cancer I assume the physicians at the time considered that as the priority, treating a disease which if untreated leads to death at that time rather then not doing it due to possible complications in 10-15 years time (possible not certain, percentage of severe stenosis in that study I mentioned is higher by 25%). So it is not a question of ignoring, but of choosing the lesser evil. Medicine is all about percentages and weighing the pros and cons, there is not a single medication or procedure which doesn't have some percentage of complications on paper, but when necessary they must be used.
As for the damage to the carotid can't really say without knowing more on imaging, 80% is quite severe but in addition there is the length of the narrowed segment and the state of the vessel wall.
Yes he's lucky this stroke he's had is a minor one, but the fact that the stroke he's had is small doesn't give any indication on the state of the artery. In fact there can be cases with severe stenosis who may be completely asymptomatic, but carry nevertheless the potential for causing a major stroke in the future.
Read below
Detailed Answer:
Hello again!
Since he was being treated for cancer I assume the physicians at the time considered that as the priority, treating a disease which if untreated leads to death at that time rather then not doing it due to possible complications in 10-15 years time (possible not certain, percentage of severe stenosis in that study I mentioned is higher by 25%). So it is not a question of ignoring, but of choosing the lesser evil. Medicine is all about percentages and weighing the pros and cons, there is not a single medication or procedure which doesn't have some percentage of complications on paper, but when necessary they must be used.
As for the damage to the carotid can't really say without knowing more on imaging, 80% is quite severe but in addition there is the length of the narrowed segment and the state of the vessel wall.
Yes he's lucky this stroke he's had is a minor one, but the fact that the stroke he's had is small doesn't give any indication on the state of the artery. In fact there can be cases with severe stenosis who may be completely asymptomatic, but carry nevertheless the potential for causing a major stroke in the future.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, this is very informative. This evening in hospital he was having periods of confusion that come and go. If this is due to the blood flow issue, can one ssume it will subside after the stent is inserted?
Brief Answer:
Possible but dementia is more likely.
Detailed Answer:
It is possible that the episodes have to do with the lowered blood flow to the brain, in that case the stent would help.
However you also say he has dementia. In that case that may play a more important role. Elderly patients with dementia, even a mild one, when suddenly taken away from home, from their familiar environment which helps them stay in touch, exposed to new surroundings with lights, new faces etc, may have a temporary worsening which may manifest with confusion. So that would be a more likely trigger in my opinion. In that case the eventual return home after the procedure should help.
Possible but dementia is more likely.
Detailed Answer:
It is possible that the episodes have to do with the lowered blood flow to the brain, in that case the stent would help.
However you also say he has dementia. In that case that may play a more important role. Elderly patients with dementia, even a mild one, when suddenly taken away from home, from their familiar environment which helps them stay in touch, exposed to new surroundings with lights, new faces etc, may have a temporary worsening which may manifest with confusion. So that would be a more likely trigger in my opinion. In that case the eventual return home after the procedure should help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. Thankfully is overall health is good for his age, and enjoys following the news, conversing, going out to movies and dinner and drives. Unfortunately he tends to repeat questions and stories and has the usual short term memory loss. We can close the discussion now. Thanks.
Brief Answer:
Wish him the best of luck.
Detailed Answer:
I sincerely hope the procedure will be a successful one and he will resume his normal activities, it is good to see he stays active at his age. Wishing you and your family good health.
Wish him the best of luck.
Detailed Answer:
I sincerely hope the procedure will be a successful one and he will resume his normal activities, it is good to see he stays active at his age. Wishing you and your family good health.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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