How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Daniel Nelson, MD Your Own Question
Daniel Nelson, MD
Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience:  Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
Type Your Health Question Here...
Daniel Nelson, MD is online now
A new question is answered every 9 seconds

Is there a way to unblock a very slightly blocked carotid ...

Resolved Question:

Is there a way to unblock a very slightly blocked carotid artery without surgery?
Submitted: 8 years ago.
Category: Health
Expert:  Daniel Nelson, MD replied 8 years ago.
Can you tell me the percentage of the occlusion estimated by either duplex carotid ultrasound or carotid angiogram? Do you have any symptoms of carotid disease, such as ministrokes (called TIA or RND), a grey cloud coming over your visual field in that eye on the same side as the carotid artery in concern?
Customer: replied 8 years ago.
I don't have a percentage. It was done by Lifeline
screening and they said it was mild/moderate.
Customer: replied 8 years ago.
Reply to XXXXX XXXXX, MD's Post: I have none of the symptoms you describe
Expert:  Daniel Nelson, MD replied 8 years ago.

Dear Lindran,

I believe that Life Line Screening services performs a simple Doppler colorflow ultrasound (aka duplex carotid ultrasound). They should have been able to provide a percentage occlusion value by this type of testing. Your question is, can a very slight blockage of the carotid artery be unblocked without surgery (the surgery is know as carotid endarterectomy, or CEA)? I will indeed address that question, and provide some additional information for you so that you can address this issue with your own physician in the near future. Being informed will give you the most value in your future appointments with any physician.

In 2001, the Stroke Council of the American Heart Association came out with a "consensus statement" ... a statement of agreement based upon the study results to-that-date of what to do in instances of carotid artery blockage without symptoms. The statement is that surgery is of greater benefit than no surgery in men without symptoms of blockage, age 40 to 75, with at least 60% blockage of the carotid artery and no other major medical conditions or major blockages on the other carotid artery. I am paraphrasing a great deal, because the consensus statement is lengthy, but this is the essence of it.

Now, to answer your question. YES. We can perform carotid balloon angioplasty and also place carotid stents (little wire tubes that hold the carotid artery open). The problem here is that the outcomes of the studies to-date are very conflicting, and it appears that the CEA Surgery remains the recommended choice for men fitting the criteria for the Stroke Council of the American Heart Association Consensus Statement.

So, at this time, I cannot recommend to my patients with asymptomatic (no symptoms of blockage) blockage of the carotid arteries greater than 60%, that they undergo angioplasty or stent placement. Carotid endarterectomy is still the preferred choice in most people, especially otherwise healthy men, with greater than 60% or greater blockage of a carotid artery. Their long term benefit over a period of years is much greater than those who do not undergo the CEA surgery.

Let me know if you have further questions or concerns.

Thank you for visiting's Health Information. I hope that all of your concerns have been addressed and that your experience here was positive and helpful. If you have a new or different question, please don't hesitate to come back or submit a new question. It has been a pleasure helping you. Your FEEDBACK is very important to me.

Customer: replied 8 years ago.
I'm actually a woman. Do the guidelines apply to women?
Expert:  Daniel Nelson, MD replied 8 years ago.

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.


Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience: Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
Daniel Nelson, MD and 6 other Health Specialists are ready to help you
Customer: replied 8 years ago.
I'm having another test in March to see if the condition is stable or progressing. Meanwhile I do take an aspirin a day and I'm on statins for my cholesterol which is around 200 with good LDL and HDL ratios. It's interesting how different the treatments for men and women are.
I live in Durham near Duke University Hospital. I'm sure I can find a very qualified Dr. to help me if need be. Thanks for your help.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Previous | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ

Meet The Experts:

  • Family Physician

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    Emergency Medicine and Family Practice for over 26 years
< Last | Next >
  • Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    Emergency Medicine and Family Practice for over 26 years
  • Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • Dr. Ketch's Avatar

    Dr. Ketch


    Satisfied Customers:

    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    Board Certified NP, MS, RN. Private practice & hospitalist
  • Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    U.S. Physician/Surgeon in Neurosurgery
  • Dr. Gupta's Avatar

    Dr. Gupta

    Doctor (MD)

    Satisfied Customers:

    Vastly experienced MD Physician with 19 years of experience.

Related Health Questions