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Carotid Stenosis?? #4600885
12/11/17 06:05 PM
12/11/17 06:05 PM
Joined: Jan 2006
Posts: 2,434
Michigan
stockrex Offline OP
stockrex  Offline OP
Joined: Jan 2006
Posts: 2,434
Michigan
Greetings,

Grandma is a possible carotid stenosis on her right side. We have a CT scheduled for next week, with and without dye.
Problem is she does not tolerate CT dye very well, last time it was close one.

Anyone have any experience with Carotid blockage/narrowing?


07Ridgeline:33k,08Dmax:14k,10Fit:40k:90Toyota1Ton:88k
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Re: Carotid Stenosis?? [Re: stockrex] #4600894
12/11/17 06:18 PM
12/11/17 06:18 PM
Joined: May 2005
Posts: 10,276
ROCHESTER, NY
Char Baby Offline
Char Baby  Offline
Joined: May 2005
Posts: 10,276
ROCHESTER, NY
Prayers sent. God Bless Grandma!


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Re: Carotid Stenosis?? [Re: stockrex] #4600911
12/11/17 06:42 PM
12/11/17 06:42 PM
Joined: Mar 2017
Posts: 16
WI
Mazomopar Offline
Mazomopar  Offline
Joined: Mar 2017
Posts: 16
WI
Hi Stockrex
I'm a vascular sonographer, doing ultrasound imaging. The doc's will talk in percentages of narrowing. Usually surgery will be with 60-70% or greater narrowing. You have a carotid artery on each side of your neck,shaped like a "Y". The internal branch goes to the brain and is usually where most of the concern is. Fortunately, the carotid on the oposite side of the neck helps carry the load. An open procedure is most common, 3-4 hours, however a lot of stenting is being done. I have the honor of working in a Veterans hospital,caring for those who have borne the battle. Best of luck.

Re: Carotid Stenosis?? [Re: stockrex] #4600925
12/11/17 07:03 PM
12/11/17 07:03 PM
Joined: Mar 2014
Posts: 3,255
NJ
Leo99 Offline
Leo99  Offline
Joined: Mar 2014
Posts: 3,255
NJ
Can they do angiogram instead of CT so that they won't need to use dye?


Without data you're just another person with an opinion. W. E. Deming

2003 Corolla 250,000 miles
2004 Rav4 359,000 miles
2015 Camry 59,000 miles
Re: Carotid Stenosis?? [Re: Leo99] #4600948
12/11/17 07:29 PM
12/11/17 07:29 PM
Joined: Dec 2009
Posts: 484
Ohio
radtech91 Offline
radtech91  Offline
Joined: Dec 2009
Posts: 484
Ohio
Originally Posted By: Leo99
Can they do angiogram instead of CT so that they won't need to use dye?


Angiogram still uses iodine contrast.

I'm a CT Tech and we do CTA (CT Angiogram) necks all the time for carotid stenosis. If she's allergic to the iodine contrast they should have her pick up and allergy prep. Usually started 13 hours prior to the test and consisting of Benadryl, solumedrol and prednisone.


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Re: Carotid Stenosis?? [Re: stockrex] #4600965
12/11/17 07:55 PM
12/11/17 07:55 PM
Joined: Apr 2014
Posts: 569
WV
loneryder Offline
loneryder  Offline
Joined: Apr 2014
Posts: 569
WV
Thanks guys for providing some good info for the OP. I do know the surgery used to be very serious but they have really improved it. Lot of people go home the next day now.

Re: Carotid Stenosis?? [Re: stockrex] #4600981
12/11/17 08:12 PM
12/11/17 08:12 PM
Joined: May 2010
Posts: 9,046
North Carolina
spasm3 Offline
spasm3  Offline
Joined: May 2010
Posts: 9,046
North Carolina
Originally Posted By: stockrex
Greetings,

Grandma is a possible carotid stenosis on her right side. We have a CT scheduled for next week, with and without dye.
Problem is she does not tolerate CT dye very well, last time it was close one.

Anyone have any experience with Carotid blockage/narrowing?



How long ago was the CT scan where she had difficulty with the contrast? If it was a really long time ago, its possible she received Ionic contrast( renografin/conray etc). Ionic contrast caused nausea, vomiting , lowered blood pressure and in cardiac use , sometimes a-sytole. These would be non allergic reactions. An allergic reaction would be hives, itching, larygospasms, difficulty breathing, swelling of the tongue, dangerously low blood pressure, at that point we call it anaphylaxis.

Most procedures now, use non-ionic contrast media.( Isovue, Visipaque,Omnipaque.)

Knowing her age would help. Some patients are candidates for carotid stenting. Just remember the risk of stroke is there for any procedure, stenting or open. It is higher with age and calcified arteries. And if there are other co-mobitities. The atherosclerotic process is same disease , just a matter of where it is I.E. carotid, coronary artery, renal artery etc. The difference its the vessel size, what is down stream from it, how hard of soft the plague is( calcification). Whether the plague is eccentric, or concentric as well. lesion length comes into play, but usually less than 60-70% stenosis is left alone, but again lesion length matters as well as cross section area. Also how close it is or runs into the bifurcation.

Here is a image, as well as some anatomy.



[img:center]https://www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/images_241[/img]

[img:center]https://qph.ec.quoracdn.net/main-qimg-e790caad5ed19e1b7037a45b19f635fe-c[/img]

Sometimes with advanced age, medical management can be the safest choice.


Last edited by spasm3; 12/11/17 08:24 PM.

13 elantra 70k 5w30 QSUD
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Re: Carotid Stenosis?? [Re: stockrex] #4601004
12/11/17 08:34 PM
12/11/17 08:34 PM
Joined: May 2010
Posts: 9,046
North Carolina
spasm3 Offline
spasm3  Offline
Joined: May 2010
Posts: 9,046
North Carolina
I meant to include in my last post. Just make sure they know she had a issue with contrast. If you know the year and what reactions she had, thats better.

She can be pre-medicated if contrast is absolutely necessary. Usually that consists of prednisone or solu-medrol 12hrs prior and the morning of procedure, along with 25-50mg of diphenhydramine , and 20mg of famotidine.

Last edited by spasm3; 12/11/17 08:35 PM.

13 elantra 70k 5w30 QSUD
03 chevy avalanche79k synpwr 10w30
01 saturnsc1 185k synpwr rebuilt
17 mazda cx-5 5600 miles m1 0w30
Re: Carotid Stenosis?? [Re: stockrex] #4601011
12/11/17 08:46 PM
12/11/17 08:46 PM
Joined: Mar 2014
Posts: 3,255
NJ
Leo99 Offline
Leo99  Offline
Joined: Mar 2014
Posts: 3,255
NJ
Lots of good info. Thanks for sharing the knowledge.


Without data you're just another person with an opinion. W. E. Deming

2003 Corolla 250,000 miles
2004 Rav4 359,000 miles
2015 Camry 59,000 miles
Re: Carotid Stenosis?? [Re: Mazomopar] #4601033
12/11/17 09:16 PM
12/11/17 09:16 PM
Joined: Jan 2006
Posts: 2,434
Michigan
stockrex Offline OP
stockrex  Offline OP
Joined: Jan 2006
Posts: 2,434
Michigan
Originally Posted By: Mazomopar
Hi Stockrex
I'm a vascular sonographer, doing ultrasound imaging. The doc's will talk in percentages of narrowing. Usually surgery will be with 60-70% or greater narrowing. You have a carotid artery on each side of your neck,shaped like a "Y". The internal branch goes to the brain and is usually where most of the concern is. Fortunately, the carotid on the oposite side of the neck helps carry the load. An open procedure is most common, 3-4 hours, however a lot of stenting is being done. I have the honor of working in a Veterans hospital,caring for those who have borne the battle. Best of luck.



Mazo, She has pain right below her right ear around the neck area, any pressure on the carotid and she feels like she will black out.

Do they have a doppler test which measure flow while she moves her head around? I ask cuz her issues show up at certain angles only.


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Re: Carotid Stenosis?? [Re: Char Baby] #4601034
12/11/17 09:17 PM
12/11/17 09:17 PM
Joined: Jan 2006
Posts: 2,434
Michigan
stockrex Offline OP
stockrex  Offline OP
Joined: Jan 2006
Posts: 2,434
Michigan
Originally Posted By: Char Baby
Prayers sent. God Bless Grandma!


Thanks, I am praying it is something simple.


07Ridgeline:33k,08Dmax:14k,10Fit:40k:90Toyota1Ton:88k
Oil Whisperer!*Fear the DINO*
Re: Carotid Stenosis?? [Re: stockrex] #4601044
12/11/17 09:26 PM
12/11/17 09:26 PM
Joined: Jan 2006
Posts: 2,434
Michigan
stockrex Offline OP
stockrex  Offline OP
Joined: Jan 2006
Posts: 2,434
Michigan
radtech/spasm3,
She is 68, she had a CT with dye in 2008, the dye caused her BP, pulse to shoot up, she nearly stroked.

Yes, the PCP provided the prednisone, benedryl instructions.

But as you can see her reaction to the dye was not an allergic reaction but she has the same reaction with some nsaids.

Would doing the CT without the dye yield any value?


07Ridgeline:33k,08Dmax:14k,10Fit:40k:90Toyota1Ton:88k
Oil Whisperer!*Fear the DINO*
Re: Carotid Stenosis?? [Re: stockrex] #4601073
12/11/17 10:09 PM
12/11/17 10:09 PM
Joined: May 2010
Posts: 9,046
North Carolina
spasm3 Offline
spasm3  Offline
Joined: May 2010
Posts: 9,046
North Carolina
Originally Posted By: stockrex
radtech/spasm3,
She is 68, she had a CT with dye in 2008, the dye caused her BP, pulse to shoot up, she nearly stroked.

Yes, the PCP provided the prednisone, benedryl instructions.

But as you can see her reaction to the dye was not an allergic reaction but she has the same reaction with some nsaids.

Would doing the CT without the dye yield any value?



I'm going to leave the contrast CT question to Radtech 91, as i'm not that knowledgeable about CT itself.
Her procedure in 2008 would most likely have been non-ionic contrast. Most ionics were out of cardiac use in the late 80's early 90's.

I would be concerned that if she is passing out or almost passing out with pressure on the right side, and or turning her head. My concern would be if the left carotid is open or severely stenosed as well. It sounds somewhat like the left is unable to assist with perfusion when the right is compromised.

Again, i'm no physician.

At age 69, i have to ask if she smokes. Or is diabetic and poorly controlled. Both of those are key to this. If she smokes and does not stop all this will be for naught, same for maintaining tight control on her blood sugar levels.

Last edited by spasm3; 12/11/17 10:20 PM.

13 elantra 70k 5w30 QSUD
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01 saturnsc1 185k synpwr rebuilt
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Re: Carotid Stenosis?? [Re: stockrex] #4601164
12/12/17 12:16 AM
12/12/17 12:16 AM
Joined: Dec 2009
Posts: 484
Ohio
radtech91 Offline
radtech91  Offline
Joined: Dec 2009
Posts: 484
Ohio
Originally Posted By: stockrex
radtech/spasm3,
She is 68, she had a CT with dye in 2008, the dye caused her BP, pulse to shoot up, she nearly stroked.

Yes, the PCP provided the prednisone, benedryl instructions.

But as you can see her reaction to the dye was not an allergic reaction but she has the same reaction with some nsaids.

Would doing the CT without the dye yield any value?



Only way to look at the arteries is to have the contrast, sorry. Won't be diagnostic without it.


2018 Mazda CX-5 Grand Touring AWD

Previously Owned:
2014 Ford F-150 XLT 4WD
2010 Honda Ridgeline RT 4WD
2009 Honda CR-V EX 4WD
2007 Honda Element EX 4WD
Re: Carotid Stenosis?? [Re: spasm3] #4601351
12/12/17 09:50 AM
12/12/17 09:50 AM
Joined: Jan 2006
Posts: 2,434
Michigan
stockrex Offline OP
stockrex  Offline OP
Joined: Jan 2006
Posts: 2,434
Michigan
Originally Posted By: spasm3


At age 69, i have to ask if she smokes. Or is diabetic and poorly controlled. Both of those are key to this. If she smokes and does not stop all this will be for naught, same for maintaining tight control on her blood sugar levels.


spasm,
Non smoker and no diabetes, htn and gout and both controlled.

If she applies compression on the left side (carotid) the right side feels heavy(er).

I am calling to find out what dye they want to use.


07Ridgeline:33k,08Dmax:14k,10Fit:40k:90Toyota1Ton:88k
Oil Whisperer!*Fear the DINO*
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