Q: An ultrasound of my right carotid artery shows a 60 percent to 80 percent blockage. My doctor mentioned that I might need an endarterectomy. Please explain this procedure.
-- V.B., Debrary, Fla.
A: Finding that a main artery to the brain is partially blocked can be scary. I hope you have already spoken with your doctor and are beginning to deal with what it means to have blockage in this artery.
To understand endarterectomy (the surgical removal of a build-up of material on the inside of an artery) I'll first give some background information.
The lining of arteries develop deposits, called plaques, and thickening of the walls. This occurs as we age, but the amount is greatly accelerated as the result of certain diseases, such as high blood pressure and diabetes.
The most common sites for this to occur are the major artery of the body (the aorta), the arteries to the brain (the carotids) and the arteries to the heart muscles (the coronaries). The large arteries of the legs (the femorals) and even smaller arteries in the legs are also major sites of occurrence.
The plaques are made up of many substances, but fats, especially cholesterol, and blood clots are major components. As the plaques get bigger and rougher, they cause more and more deposition of clots (thrombi).
As the thrombi age, small pieces begin to break off. These pieces then float downstream until they get stuck in a small artery. The disruption of blood flow causes many symptoms from blurred vision to paralysis to passing out.
Usually these symptoms go away within 24 hours because the thrombus dissolves or a new route for blood flow takes over. These medical events are called transient ischemic attacks (TIAs).
When the size of a thrombus gets large enough, two things happen. First, much larger arteries are blocked. Second, the blockage lasts a longer time. Therefore, the symptoms are worse and the brain tissue affected is much more likely to die -- making the change more permanent.
There are two approaches to helping someone with blockage of the carotid arteries. One can use anti-coagulants -- aspirin is the one primarily used -- or have a surgical procedure called carotid endarterectomy.
Research has shown that the approach that provides the best outcome depends on the amount and characteristics of the blockages and whether the person has had or is having symptoms. That's because the surgery creates an increased risk of strokes and death.
Before deciding on the exact amount of blockage and to better prepare for surgery, another test called angiography is usually recommended. In this test, dye is injected into the bloodstream and X-rays of the area are taken.
Certain surgeons and medical centers have much better success than others do. So I recommend you only have the procedure done when the past record indicates that your combined risk of major complications of surgery and angiography are less than 5 percent.
You obviously are facing a major medical problem. You need to find out more about your situation and talk at length with one or more doctors about your risks and benefits of medical vs. surgical treatment.
UPDATE ON ECZEMA: A study recently reported in the Archives of Dermatology indicates that a type of interferon may be a more effective long-term treatment for atopic dermatitis (eczema).
That's good news for many people who have been so frustrated by this disease. Previous treatments have been only partially effective, and they can have significant side effects if used for long periods of time.
Interferon is not a complete cure and, unfortunately, it has to be injected under the skin; it is expensive to use over long periods of time. Even so, it may be the best option for many people.
Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is DRFamily@aol.com.
This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.