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Carotid cholesterol.

There is an honest difference of opinion among cardiologists, neurologists, and internists about when to intervene in cases with 80 percent carotid blockage without symptoms.

Dr. Stuart Nelson is a physician in the Fort Worth, Texas, area who has collected histories of patients with evidence of blockage, and he reports good results in reversing it. He told us that with diet and medication, he has seen patients who "had been 100 percent plugged up who are 50 percent plugged up now." He said he had discovered such improvement on ultrasound pictures in as little as six to eight months. He told us of one woman whose 80 percent blockage was reduced to 40 percent as revealed by before-and-after ultrasound tests.

His optimism is extremely good news for people who are reluctant about surgery when they have no symptoms from this problem. the blocked carotid during a physical when they hear a typical kind of turbulence of the blood being forced past the obstruction. They call this sound a "bruit."

They then recommend the Doppler/ultrasound tests. The Doppler test magnifies the noise of the blood going through, and the ultrasound shows, in color, the turbulence of the blood being forced past the obstruction. The high-frequency sound waves can be directed right to the center of the artery.

It is fortunate that the ultrasound equipment can print out colored pictures of the obstruction to show the patients, as these create very potent incentives for patients to adhere to their low-fat and no-cholesterol diets.

Surgery to remove cholesterol plaques form the bifurcation (fork) of the carotid is a common procedure for a regrettably common problem. The procedure is called an endarterectomy. According to Dr. Nelson, those who have their obstructions removed at the bifurcation of the carotid still need to adhere to a low-fat and no-cholesterol diet, since the plaques would rarely be present in only one place in the vascular system.

Smaller vessels in the brain may also be forming plaques. Another common place for plaques is in the coronary arteries of the heart.

Dr. Nelson takes a serious interest in those with carotid obstructions. He studies the HDL and LDL cholesterols and also looks at the apolipoproteins test results. Damon Laboratories do the tests for him. He does phenotyping of the patient to help determine the most appropriate treatment.

There is good rationale for knowing the condition of one's carotid arteries. For example, we're told that if an obstruction has developed over a period of years, the auxiliary circulation from the complex of arteries called the circle of Willis can take over providing blood to the impaired or vulnerable side of the brain. This is possible because the circle of Willis receives blood from the basilar artery via the vertebral artery which comes up from the back and is completely independent of the carotids. If the obstruction is a recent event, the auxiliary circulation may not be there, and the risk for a stroke is greater.

Dr. Dean Omish from the School of Medicine at the University of California in San Francisco puts his patients on a 10 percent fat and no-cholesterol diet to reverse their cholesterol plaques. He finds patients who continue to get worse when they follow the recommendations of the American Heart Association. They need the stricter 10 percent fat and no-cholesterol diet for regression of the plaque, he told us. (The American Heart Association allows 30 percent fat.)

The NIH reports that more than 100,000 endarterectomies are performed in the U.S. each year. Far fewer per capita are performed in England.
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Title Annotation:intervention in carotid blockage cases
Publication:Medical Update
Date:Oct 1, 1991
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