Neck artery surgery can prevent strokes

Dear Dr. Donohue: During my yearly exam, my doctor heard a noise in my left neck artery. He sent me to have a scan, which showed I have a 75-percent blockage in that artery. He says I should have surgery. I have heard that this is very risky surgery and I could end up with a stroke or worse. What’s your opinion? What can I do other than surgery to prevent a stroke? — X.B.

Answer: Strokes result from interruption of blood flow to a part of the brain. An obstruction in the right or left carotid artery — the two large neck arteries that supply the brain with blood — is one cause for a stroke, and it is a major cause. The obstruction in those neck arteries arises for the same reasons that obstructions in heart arteries arise — high blood cholesterol, smoking, inactivity, high blood pressure, diabetes, genes and unknown factors.

A 75-percent obstruction is a very significant obstruction and puts you at high risk for having a stroke. Reaming out the obstruction — a carotid endarterectomy — or replacing the site of obstruction with a graft takes you off the list of people likely to have a stroke. The surgery does have risks. It can cause a stroke or even death, but the risk is small compared with the risk of doing nothing.

Blocked heart arteries can sometimes be unplugged by dilating them with a balloon-tipped catheter, and that procedure is under evaluation for blocked carotid arteries.

If I faced your dilemma, I would choose surgery.

Alternatives to surgery include taking medicines that lower cholesterol, just as people with heart artery blockages do. Blood pressure control is important. Lifestyle changes — exercise, weight loss, not smoking, and moderating salt use — are other elements that can slow the progression of an obstruction.

More than three-quarters of a million North Americans will suffer a stroke this year. Readers who would like more information on strokes, their treatment and prevention can order the stroke booklet by writing: Dr. Donohue — No. 902W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

Dear Dr. Donohue: In the past year, my voice began to quaver. I mentioned it to my doctor, and he said it was a family tremor. Really? Nothing else on me shakes. My hands are as still as a sheet of ice. Is there treatment for this? — R.J.

Answer: Familial tremor, also known as essential tremor, usually involves the hands. They shake when performing a specific task, like bringing a cup of coffee to the mouth. Muscles control vocal cords, and familial tremor can, therefore, lead to a quivering voice.

If treatment is truly necessary, you might try a beta-blocking drug like Inderal.