Health Update – Carotid Artery Dissection with Pseudoaneurysm.

A short report that is nice because it contains good news. We are seven months since the diagnosis of a carotid artery dissection. My husband got called in for an MRI. The reason for the doctors being concerned about this is because my husband is at a much higher risk of throwing a clot due to the healing carotid artery dissection with a large pseudoaneurysm because of narrowing at the site of the injury.  You may recall there was a debate about stenting (relatively high risk especially when compared with his clinical symptoms which are none.) The MRI was for testing if the carotid artery dissection caused a stroke of if it is throwing off small clots and causing micro strokes. Micro strokes are tiny strokes that do not show up clinically but accumulate over time and eventually can lead to dementia. They can only be seen using MRI. Our doctor gave us a copy of the report on the MRI and the neurologist’s report and it was overall positive.

The MRI did not show sign of anything beyond a “smooth narrowing” of the artery. Compared to the last report from October with a CT that is an improvement. To be properly cautious, it is hard to compare across modalities however since the clinicians seem to think that’s a positive improvement, we’ll definitely take it. There is still a thrombus/clot where there was before but the MRI seems to show it was smaller (again the cross modality issue makes me hesitant to say it.) Also the MRI works by producing a specific signal when a specific magnetic frequency is used. The signal that came back was for a blood clot and not the later final stage of a healed clot. It apparently takes 4-6 months for this process to start so it is not a surprise nor is it bad news. It just means the healing is not finished. The thrombus certainly is no bigger.

The really good news is the MRI could not detect the stroke damage. Strokes show up as bright spots and the brighter and more solid the spot, the worse the stroke. In my husband’s case there is only one very small, very faint and only slightly brighter spot and no where near where he should have he had caused by the carotid artery dissection. Best of all, no sign of any other micro strokes or secondary damage or anything else. He has two tiny plaques in his arteries, matched on both sides, which are often found even in healthy young men and we already knew about those from the previous CTs. The letter from the neurologist states he has ruled out any progressive neuropathies or vasculopathies (i.e. blood vessels and nerves, brain are as normal as can be for 76 years). The specialist thinks it was just the unlucky seatbelt accident. Further our family doctor told us he can confidently state my husband is now clinically stable if a travel insurance company were to ask. (Due to the past history of carted artery dissection that might still be an issue but we’re not ready to start traveling right now anyway.)

We also got permission to try reducing the last of three blood pressure medications he is on back down to the level he was using to control his blood pressure before all this started. (He has been on a double dose of his ace inhibiter since the dissection after using it for many years to lower his blood pressure.) Again, it has to be done carefully with daily monitoring twice a day (morning before taking the pill and evening) but six days into it and my husband’s blood pressure has actually been a bit lower sitting nicely at about 130/80 give or take 5 points with the majority being about 125/75 for the evening check and slightly higher for the morning check before taking the pill.

There we are. Slight improvement, no sign of the bad stuff the MRI was supposed to detect, no need for stenting at this time, no more visits to the doctor until late spring unless something changes. Blood pressure med down to the previous level. At some future point yet to be determined, another imaging check of the artery will be done (likely by ultrasound) and if it is healed my husband can stop taking the generic plavix blood thinner although the neurologist said he should be taking a baby aspirin for the rest of his life.

There is a special Hebrew blessing for when one has had a near miss with death and been delivered from it. I am tempted to ask my husband to arrange now. (It has to be said in a minyan of ten Jews after a Torah reading) but I won’t just yet. Instead, I’ll ask for the continued healing prayer to keep on being said since we are not all the way there yet. (You can hear a woman sing the prayer in Hebrew here.) In English it goes like this:

May the One who blessed our ancestors Abraham, Isaac, and Jacob, Sarah, Rebecca, Rachel, and Leah bless and heal Yitzhak son of Dina. May the Holy Blessed One overflow with compassion upon him, to restore him, to heal him, to strengthen him, to enliven him. The One will send him, speedily, a complete healing, healing of the soul and healing of the body along with all the ill, among the people of Israel and all humankind, soon, speedily, without delay, and let us all say:  Amen!

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