In women the results of surgery are not clearly beneficial, and we generally recommend medical management for women with asymptomatic carotid blockage. This is considered a weak recommendation, based on moderate-quality evidence. One of the problems with the few reliable studies upon which we base these conclusions is that there was not a clear benefit shown for women, and that in another study the risks and benefits for women were not assessed or assessible.
Each person, however, is an individual and their circumstances vary widely. I would have you obtain a report of your Life Line Screening study (it sounds like you already have), and if there is no percentage occlusion listed and it only states "mild-moderate," then it may be of use to get a more definitive study that will show a more defined percentage of occlusion. Carotid angiography is the gold standard. But in the end, we are still left with the fact that the risk versus benefit ratio in women without symptoms is undefined.
I will tell you this, we DO perform carotid surgery on asymptomatic (without symptoms) women, but it is on a case by case basis. The selection criteria are variable, and the input and expectations of the patient are also very important to us. I would recommend discussing this with a physician proficient in CEA surgery, in a major centre where this surgery is performed regularly and with low complication rates of 3% or less for both the institution and the surgeon. One thing to keep in mind, especially if the percentages are higher than 3%, is that this may be due to the fact that the particular surgeon accepts the most severely ill patients at highest risk whereas others may not. So even percentage success and complication alone are not enough to rely upon. I do still recommend a centre and surgeon who perform this procedure regularly if you are considering further evaluation.
Medical management may consist of blood thinner medications like a baby aspirin per day, other anti-platelet medications, and "statins" like Lipitor or Crestor ... the statins help to stabilise atherosclerotic plaques and prevent them from rupturing and causing a stroke, plus, there are other benefits from statins in stoke prevention that we don't yet understand because they effect over 20 steps in the chosterol handling pathways in the body ... but almost all in a good way.
Definitive evaluation of the percentage of occlusion.
Evaluation by a physician who specialises in carotid vascular disease, such as Internal Medicine Cardiovascular Diseases (cardiology vascular specialists), Vascular Surgery, Neurosurgery.
Discuss medical management versus invasive management once all of your data, including a percentage blockage, as well as thorougth history and physical examination, and risk assessment labs, have been completed.
Medicines versus Intervention:
Aspirin, other anti-platelet medications, "statins" versus CEA Surgery versus Angioplasy versus Stent.
Based on what I have heard so far, it sounds like medical management is the most sound, evidence-based answer. But, because I cannot see you or examine you, plus, I cannot ask all the questions I would like to ask or arrange for certain blood tests or a more definitive assessment of the percentage and location of occlusion, there may be a possibility of recommending intervention. The problem is, there is no consensus for women, yet. The use of stents and angioplasty are not definitive in the medical literature. We need more time and more studies to know for sure whether angioplasty or stenting is superior to, inferior to, or on par with surgery in certain individuals. We need more studies with women who undergo surgery (CEA) and evaluation of risk versus benefit, long term outcomes assessment, and studies that do not contain flaws like several have had.
XXXXX XXXXX, MD