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Dr. Andrew Rynne

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Suggest treatment for internal carotid stenosis

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Dr. Ajay Panwar

Neurologist

Practicing since :2007

Answered : 1794 Questions

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Posted on Thu, 5 Nov 2015 in Brain and Spine
Question: My father in law, 85 years was admitted to hospital with symptoms of fever and disorientation during XXXXXXX 2015. It was revealed that he had suffered cerebral stroke.MRI of brain revealed that he had suffered water shed infarct in the frontoparietal lobe and carotid doppler study showed that he had significant stenosis in the left ICA. He was discharged from hospital in stable condition with the advice to take the following medications: Neksium 40 mg( twice daily)/stugeron 25 mg thrice daily/tonact 40/deplatt A 75/thronorm 50/cilacar 10/orofer syrup/ metaspan/eporise injection 4000-weekly and soliten 10

In the follow up check done in July, the same doctor advised continuation of the same medicines and advised check up after 6 weeks. In September, when he was taken for the check up, the doctor advised continuation of the same medicines and discontinued the use of metaspan. He was asked to come for a checkup in October after getting a carotid doppler done.

A carotid doppler study was done on 13th october which showed partially calcified plaques involving carotid bulbs , bilateral proximal external and internal carotid arteries causing moderate to near complete stenosis(75%-99%) of proximal left internal carotid artery and mild to moderate( 50-70%) stenosis of proximal right internal carotid artery.

If I compare the carotid doppler done while he was admitted in the hospital against the one done in october it would be apparent that the blockage has increased. I am getting the feelings that the medicines prescribed by the doctor are not having any effect.

Considering the situation, his age and overall health condition, can you please let me know what is it I need to do ? I would need some guidance on the various options that are feasible at this stage and what are chances of success?


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Answered by Dr. Ajay Panwar 1 hour later
Brief Answer:
Continue same medicines/vascular surgeon's opinion.

Detailed Answer:
Hi XXXXXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

I have gone through your father's clinical details as mentioned above.In the present scenario,for internal carotid stenosis-a vascular surgeon's opinion should be taken regarding 'endarterectomy'.Please discuss with the treating neurologist regarding this, as well.

Meanwhile,medicines are to continue as such.Medicines have more of a preventive role than curative.Further,it is not confirmatory whether inspite of taking medicines,disease will progress or not.Progression depends on many risk factors.But one thing is sure,that if the medicines are discontinued-it will cause more harm.Medicines as prescribed are fine and according to treatment protocol.

If you have further questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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