Carotid Artery blockage - how to manage?

It sounds like your doctor has a good handle on your situation. I would follow his advice.

As a 72 year old who also has about 70% blockage of my right carotid artery but who is asymptomatic, my surgeon would consider surgery (carotid endarterectomy) only if my blockage was to progress or if I was to develop any symptoms. I did some research on line via chatgpt about carotid artery blockage, the surgery, the various test they use (I only had the doppler ultrasound which I understand can be subject to technician and reading variability) and satisfied myself that I didn't need a second opinion at this time. I am staying the course being on a baby aspirin and a statin and will be monitored again in 6 months. The surgery carries risks. Obviously, if you get any symptoms and/or TIA symptoms, it's a 911 call. But it seems to me you're probably getting good advice given the risks of surgery and your surgeon's reputation who is taking your age and presumably your overall health in consideration.

I am an 82 year old male.

If it is of any comfort, on February 12, 2025 I had an episode of amaurosis fugax (blindness in right eye), which resolved itself with total vision recover in a few hours.

Subsequent tests showed that I had a completely occluded right internal carotid artery, and that I had had a "silent" stroke sometime in the past, that I did not notice at the time and that evidently caused little damage in the places that matter.

There was no surgery recommended because of the total occlusion. I am currently on a low dose of aspirin, and a high dose of statins.

This is now the end of October 2025, I see NO physical effects associated with my blocked carotid artery. With the permission of my doctors, I exercise daily (and have done so for many years), getting my heart rate up over 110 bpm, and am totally asymptomatic while I am doing that.

I am told this is because of collateral circulation, the body's natural backup system, consisting of a network of smaller blood vessels that can provide alternative routes for blood flow when a main artery is blocked.

The main alternate pathway for blood flow to the brain is the Circle of Willis, a ring of connected arteries at the base of the brain. This anatomical feature, combined with a network of smaller vessels, can help protect the brain from damage if one of the major arteries becomes blocked.

This alternate pathway probably became gradually more enhanced as the blockage in my right carotid artery increased over the years.

So God bless my Circle of Willis, as far as I can see the collateral circulation it provides is as good as I had before (based on decades of previous aerobic exercise that was asymptomatic), despite the fact of the total occlusion of the right carotid artery.

So even if your blockage progresses beyond 70%, it is still not clear that surgery is the best choice. That is not a choice in my case, because it is total, but the body can provide other pathways.

John Belcher

@heaviside

Thank you for posting your experience. It confirms what I had read on line that I had wondered about if it was correct which was exactly what you experienced - the development of collateral circulation even if one has completed blockage of one of their carotid arteries. It's encouraging to know that even with complete blockage of one of the carotid arteries it doesn't necessarily mean you will have stroke, although I don't know how rare it is for someone to have a complete blockage of one of the arteries and remain asymptomatic.

Thank you for the responses. I know of a lady who was completely blocked on both sides, no symptoms other than her nail beds were blue, she was only 70 at that time and had no surgery or follow up testing, just blood thinners and statins, lived to be 82 passed from cancer. I hope my body finds pathways . I did reread my U. S. report and at the
end it tells you that the report could be mis leading due to shadows, good blood flow in the other artery and 2 other things I do not understand. my Dr did not totally agree with the % feels it is lower.I actually do not know the symptoms but having no problems.cc

@elliott1953
My understanding, perhaps wrong, is that the reason they will not do surgery with complete blockage is that the complete blockage decreases the chance of a stroke because of the absence of blood flow, and that if they were to do surgery to clear it that would in fact increase the chances of a stroke, because they are opening back up the flow. At any rate, I will take my life now, so far the blockage seems to have no obvious effect, knock on wood.