1 Carotid blocked. Recommendation?

Are you symptomatic? And how severe (what %) is the blockage?

Basically options are:

1. Not to remove the blockage and instead just try to limit tyhe risk of stroke through use of anticoagulant medications etc. This is the only non-invasive option but it does not remove the blockage and would usually not be chosen if the person were symptomatic, nor if the blockage were severe (>70%) unless there were extenuating risk factors making removal of the blockage unusually risky (see below).

2. Remove the blockage via:

• carotid endarterectomy (surgically cleaning out the vessel) OR
• Carotid angioplasty (invasive but non-surgical: a catheter with a balloon is threaded from your wrist or groin into the affected artery and then the balloon inflated; often this is combined with placement of a stent to keep the vessel open.

Success rates and overall risks between the above two approaches are basically the same. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423268/

As to where to go, I recommend Dr KOSIN THUPVONG at Bangkok Hospital in Bangkok, or alternately Dr. Permyos Ruengsakulrach at the same place (he is also at Samitivej and at Phyathai 3).

Probably not what you want to hear if you are, as name suggests, based in Phuket, but there really is no comparison in the level of expertise available in Bangkok vs. Phuket.

Are you symptomatic? And how severe (what %) is the blockage?

Basically options are:

1. Not to remove the blockage and instead just try to limit tyhe risk of stroke through use of anticoagulant medications etc. This is the only non-invasive option but it does not remove the blockage and would usually not be chosen if the person were symptomatic, nor if the blockage were severe (>70%) unless there were extenuating risk factors making removal of the blockage unusually risky (see below).

2. Remove the blockage via:

• carotid endarterectomy (surgically cleaning out the vessel) OR
• Carotid angioplasty (invasive but non-surgical: a catheter with a balloon is threaded from your wrist or groin into the affected artery and then the balloon inflated; often this is combined with placement of a stent to keep the vessel open.

Success rates and overall risks between the above two approaches are basically the same. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423268/

As to where to go, I recommend Dr KOSIN THUPVONG at Bangkok Hospital in Bangkok, or alternately Dr. Permyos Ruengsakulrach at the same place (he is also at Samitivej and at Phyathai 3).

Probably not what you want to hear if you are, as name suggests, based in Phuket, but there really is no comparison in the level of expertise available in Bangkok vs. Phuket.

An "interesting" comment . An elderly friend of ours has just undergone a successful carotid endarterectomy in one of Phuket's private hospitals.

He is not complaining about a lack of expertise .

Tks Sheryl. I passed the information on. I don't know any details and I've no intend to get involved.

I was fed some relevant info= apparently cleaning the frontal Carotid is relatively easy as opposed to the 2 rear Carotid which seems to be very risky.

Is that so? May be of relevance patient is in Chiang Mai

I really don't understand what you mean, there is no "frontal" and "rear" carotid artery. the common carotid artery on each side of the neck divides into the internal and external carotids, 1 of each. Endarectomy and angioplasty can be performed on either. Are you possibly referring to cerebral arteries that branch off the carotid?

In Chinag Mai, he should seek care at Sripat. Ask for Dr. Kittipan Rerkasem if posisble.

Are you symptomatic? And how severe (what %) is the blockage?

Basically options are:

1. Not to remove the blockage and instead just try to limit tyhe risk of stroke through use of anticoagulant medications etc. This is the only non-invasive option but it does not remove the blockage and would usually not be chosen if the person were symptomatic, nor if the blockage were severe (>70%) unless there were extenuating risk factors making removal of the blockage unusually risky (see below).

2. Remove the blockage via:

• carotid endarterectomy (surgically cleaning out the vessel) OR
• Carotid angioplasty (invasive but non-surgical: a catheter with a balloon is threaded from your wrist or groin into the affected artery and then the balloon inflated; often this is combined with placement of a stent to keep the vessel open.

Success rates and overall risks between the above two approaches are basically the same. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423268/

As to where to go, I recommend Dr KOSIN THUPVONG at Bangkok Hospital in Bangkok, or alternately Dr. Permyos Ruengsakulrach at the same place (he is also at Samitivej and at Phyathai 3).

Probably not what you want to hear if you are, as name suggests, based in Phuket, but there really is no comparison in the level of expertise available in Bangkok vs. Phuket.

Dr Kosin did mine about two years ago at BK hospital. Circa 250,000thb. There is also what we call the 'Brain Hospital' very close to Rama Hospital.

MRI at Brain Hospital (a Gov Hospital) is not expensive.

They will do that operation if you are elsewhere risk free ...eg heart and lungs are okay.

Tks I passed it 6

16 years or so ago I was told I had blockages ,I was given regular checks at the Royal Free in London , at the time I asked the specialist if he would recommend ,angioplasty,his reply was he could not give advice you must make your own mind up ,to cut a long story short , on really discussing whether he would have it done ,he looked away and made some remark about something else ,I did not get it done , 16 years and counting. Fingers crossed

Would be advisable to get another doppler done to see the extent of the blockage now.

Are you on aspirin or anticoagulants?

This is exactly why

The original poster should be able to close the subject. I am the original poster and I did pass on all the information received. with this I saw my function as middleman fulfilled . To repeat this subject is closed.

Your needs may have been met, but there is no reason why others with the same condition can't also post in this thread that I can see. As long as it stays on the topic.

Would be advisable to get another doppler done to see the extent of the blockage now.

Are you on aspirin or anticoagulants?

I do take aspirin and other meds ,have done for 30 years,when I had heart surgery

I am on blood thinners (Warfarin) and do home INR testing due to a leg thrombosis a couple of years ago. My Hematologist won't take me off of it since she doesn't know the reason for the deep vein thrombosis in the first place so her assessment of risk to rewards ratio is in favor of keeping me on it forever since I tolerate it well

I assume that Warfarin is an anticoagulant like Sheryl mentioned in post # 2

On the other hand my Vascular Surgeon who is monitoring my non symptomatic carotid blockage, when asked, said that the Warfarin regimen will do nothing about the blockage, nor will it slow the process down. So he keeps track of the % blockage via twice yearly ultra sounds ( one here in Thailand and one in the US)

This is correct, anticoagulants (which warfarin is) do not in any way decrease blockage or alter its progression. What they do, however, is to reduce the risk that a small blood clot will lodge in the narrowed artery causing full blockage and a catastrophic stroke.