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