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#4600885 - 12/11/17 05:05 PM Carotid Stenosis??
stockrex Offline


Registered: 01/08/06
Posts: 2434
Loc: 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?
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#4600894 - 12/11/17 05:18 PM Re: Carotid Stenosis?? [Re: stockrex]
Char Baby Online   content


Registered: 05/25/05
Posts: 10029
Loc: ROCHESTER, NY
Prayers sent. God Bless Grandma!
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#4600911 - 12/11/17 05:42 PM Re: Carotid Stenosis?? [Re: stockrex]
Mazomopar Offline


Registered: 03/12/17
Posts: 12
Loc: 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.

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#4600925 - 12/11/17 06:03 PM Re: Carotid Stenosis?? [Re: stockrex]
Leo99 Offline


Registered: 03/30/14
Posts: 3052
Loc: NJ
Can they do angiogram instead of CT so that they won't need to use dye?
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#4600948 - 12/11/17 06:29 PM Re: Carotid Stenosis?? [Re: Leo99]
radtech91 Offline


Registered: 12/19/09
Posts: 482
Loc: 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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#4600965 - 12/11/17 06:55 PM Re: Carotid Stenosis?? [Re: stockrex]
loneryder Offline


Registered: 04/19/14
Posts: 489
Loc: 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.

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#4600981 - 12/11/17 07:12 PM Re: Carotid Stenosis?? [Re: stockrex]
spasm3 Online   content


Registered: 05/30/10
Posts: 8665
Loc: 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.



Edited by spasm3 (12/11/17 07:24 PM)
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#4601004 - 12/11/17 07:34 PM Re: Carotid Stenosis?? [Re: stockrex]
spasm3 Online   content


Registered: 05/30/10
Posts: 8665
Loc: 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.


Edited by spasm3 (12/11/17 07:35 PM)
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#4601011 - 12/11/17 07:46 PM Re: Carotid Stenosis?? [Re: stockrex]
Leo99 Offline


Registered: 03/30/14
Posts: 3052
Loc: NJ
Lots of good info. Thanks for sharing the knowledge.
_________________________
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2003 Corolla 250,000 miles
2004 Rav4 359,000 miles
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#4601033 - 12/11/17 08:16 PM Re: Carotid Stenosis?? [Re: Mazomopar]
stockrex Offline


Registered: 01/08/06
Posts: 2434
Loc: 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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#4601034 - 12/11/17 08:17 PM Re: Carotid Stenosis?? [Re: Char Baby]
stockrex Offline


Registered: 01/08/06
Posts: 2434
Loc: Michigan
Originally Posted By: Char Baby
Prayers sent. God Bless Grandma!


Thanks, I am praying it is something simple.
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#4601044 - 12/11/17 08:26 PM Re: Carotid Stenosis?? [Re: stockrex]
stockrex Offline


Registered: 01/08/06
Posts: 2434
Loc: 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?
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#4601073 - 12/11/17 09:09 PM Re: Carotid Stenosis?? [Re: stockrex]
spasm3 Online   content


Registered: 05/30/10
Posts: 8665
Loc: 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.


Edited by spasm3 (12/11/17 09:20 PM)
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#4601164 - 12/11/17 11:16 PM Re: Carotid Stenosis?? [Re: stockrex]
radtech91 Offline


Registered: 12/19/09
Posts: 482
Loc: 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.
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#4601351 - 12/12/17 08:50 AM Re: Carotid Stenosis?? [Re: spasm3]
stockrex Offline


Registered: 01/08/06
Posts: 2434
Loc: 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.
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