Carotid surgery clears the path to longer life

Decade after decade, most of us take our bodies pretty much for granted. Yet the heart is a personal odometer that adds up the years.

By Gordon Garrison, Special to the Times
Published May 29, 2007

Decade after decade, most of us take our bodies pretty much for granted. Yet the heart is a personal odometer that adds up the years.

And so one day you find that when you go out for a walk, after a few short blocks you have to take time to catch your breath. There's something you describe to yourself as discomfort - not pain, just discomfort in your chest.

After this happened to me, my wife happened to mention the incident to her doctor. She returned home and, with scarcely a hint of alarm in her voice, demanded I see a cardiologist.

I learned I had heart disease and underwent a quadruple bypass.

Five years went by and I considered that ancient history. I more or less forgot about my health. I was 70, but I was all better, right? Wrong.

Suddenly my cardiologist was wondering why she could not hear any sound from my right carotid artery, one of the two big pipes that supply blood to the brain. There was also a strange sound echoing in her stethoscope from the left carotid.

I was in trouble again.

A hasty ultrasound showed I had 100 percent blockage in the right artery (hence no sound) and 85 percent blockage in the left. Further tests showed the blood was getting to my brain through collateral vessels.

It is not uncommon for people to have severe blockage in such arteries. It occurs at points of bifurcation, or branching, such as at the knees, elbows and shoulders. Doctors refer to sites where the flow of blood is interrupted, as areas of hemodynamic stress. This refers to the movement of blood and the dynamics of blood pressure.

A prime culprit in the blockage is the decades worth of plaque that passes through them. Plaque is composed of tiny amounts of cholesterol, calcium and tissue. It resembles porridge in appearance and is named atheroma, Greek for gruel.

Plaque deposits cause a narrowing, or hardening, of the artery, much like the calcium build-up in a plumbing pipe. This hardening is termed atherosclerosis, and it has two potentially serious consequences:

- Blood flow is restricted, thus reducing delivery of oxygen and glucose to the brain.

- Particles of plaque may become dislodged to form embolisms (clots), which then travel in the blood stream and can plug smaller downstream vessels. That causes strokes.

If these strokes are relatively small, called a transient ischemic attack (TIA), they are viewed as a warning signal of a major stroke to come.

A TIA can be a few moments of blindness in one eye, something like a lacy veil that obscures vision. Or brief numbness in an arm or hand, or brief disorientation.

But I had clogged carotids and could easily bypass a TIA and move right to a major stroke.

Typically, an endarterectomy - the cleaning out of an artery - is performed to clear the carotids. Not long before my diagnosis, researchers with the National Institutes of Health had determined that, regardless of symptoms, a carotid endarterectomy is beneficial in patients with greater than 60 percent narrowing.

A few weeks after my diagnosis, and after a battery of tests, I had the operation, which took a little more than two hours. I had only the left carotid cleared.

The doctor explained that an operation on the completely blocked artery would present the possibility of any clot behind the blockage escaping, thus possibly causing a stroke. Sufficient blood can now travel to the brain through the cleared artery and two other major arteries.

As he explained the procedure to me, a slit is made in the neck long enough to include the section containing the plaque to be removed. With the artery thus exposed, the patient is given a blood thinner.

Then, the portion of the carotid to be cleaned out is isolated between clamps that halt blood flow. The artery is slit, the plaque removed and the artery is stitched closed, before the clamps are removed, restoring blood flow.

The odds of my having a stroke have been reduced by two-thirds. It took several decades to build that blockage, so I should be perhaps 120 before another operation is needed.

I'm now 82, and I have restarted my odometer.

Gordon Garrison if a freelance writer who lives in Oshawa, Ontario, when not wintering in the St. Petersburg area.

[Last modified May 28, 2007, 13:33:52]