Harvard Heart Letter

Ask the doctor: Do I really need carotid artery surgery?

Q. I am 86 years old and have high blood pressure and diabetes. As part of my last physical exam, my doctor ordered tests to check my carotid arteries. They showed that one was nearly 70% blocked. My doctor said I had to have surgery right away or I would have a stroke. Is she right? I am the only person taking care of my 88-year-old husband, and can't be away from him for long.

A. Your doctor knows you, and your medical history, far better than I do. Yet from what you have told me, you might have another option.

If you have had a stroke in the past, or have recently had a transient ischemic attack, then opening your narrowed carotid artery makes good sense, especially if you can have the procedure performed by a doctor who does it many times a year in a hospital where it is done all the time. But if the narrowing hasn't caused any symptoms, your blood pressure and diabetes are generally under control, and you don't have some other serious risk factors for stroke, then medical therapy might be an option. This would include taking an antiplatelet medication like aspirin, and a statin to stabilize the plaque in your carotid arteries.

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