Carotid Artery Stenosis / Dry Suit Neck Seal = Increased Risk of Stroke?

[Duke Dive Medicine]

Greetings.

My left carotid artery has 50% - 75% stenosis occlusion , likely the result of radiotherapy for left tonsilar cancer, with extension to the left lymph ( 1 tumour ). I am currently 4 years post-treatment and clear of any recurrence. The right carotid shows clear, though investigation thus far has been limited to doppler ultrasound.

My reading concerning the 'fix' for such stenosis indicates the strong possibility of a stent being placed to open up the arterial lumen. I'm currently awaiting a consult with a vascular surgeon & I'm itchin' to go for a cold-water dive while I wait.

Question: does the pressure exerted by my dry suit neck seal ( neoprene, snug but not excessively tight ), increase my risk for possible disruption of existing plaques, with subsequent cva?

TIA!
( Thanks in advance - not transient ischemic attack! )

Regards,
DSD,

Hi @DeepSeaDan , my first question would be, what was the indication for the doppler ultrasound of your carotids?

Best regards,
DDM

 

[DeepSeaDan]

Hi @DeepSeaDan , my first question would be, what was the indication for the doppler ultrasound of your carotids?

Best regards,
DDM

Hi DDM,

I jumped the gun a bit on this post - the reports are en route to me via snail-mail; will digest them and jump back in…

DSD

 

[DeepSeaDan]

Hi @DeepSeaDan , my first question would be, what was the indication for the doppler ultrasound of your carotids?

Best regards,
DDM

Sorry, should have checked my email 1st! the 1st scan report did get emailed; here are the highlights:

"On the left side, there is hypoechoic smooth plaque at the posterior left carotid bulb, extending into the proximal ECA. There is a 50 to 70% diameter stenosis of the left ECA, with peak systolic velocity 194 cm/s. (Right ECA PSV 94 cm/s)"

"The left CCA and ICA show no evidence of significant stenosis."

"Normal hemodynamic waveforms, flow velocities within the right CCA, ICA, and ECA."

"OPINION No significant stenosis involving the CCA or ICA bilaterally. 50 to 70% stenosis left ECA."

My research indicates the carotid bulb to be a common site for plaque occlusion.

I'll wait to see how this report compares to the 2nd report.

DSD

 

[Duke Dive Medicine]

Sorry, should have checked my email 1st! the 1st scan report did get emailed; here are the highlights:

"On the left side, there is hypoechoic smooth plaque at the posterior left carotid bulb, extending into the proximal ECA. There is a 50 to 70% diameter stenosis of the left ECA, with peak systolic velocity 194 cm/s. (Right ECA PSV 94 cm/s)"

"The left CCA and ICA show no evidence of significant stenosis."

"Normal hemodynamic waveforms, flow velocities within the right CCA, ICA, and ECA."

"OPINION No significant stenosis involving the CCA or ICA bilaterally. 50 to 70% stenosis left ECA."

My research indicates the carotid bulb to be a common site for plaque occlusion.

I'll wait to see how this report compares to the 2nd report.

DSD

@DeepSeaDan thanks for the details and apologies for any confusion... what I mean was, why was the ultrasound performed? Did you have some sort of event that led your provider to order it?

Best regards,
DDM

 

[DeepSeaDan]

@DeepSeaDan thanks for the details and apologies for any confusion... what I mean was, why was the ultrasound performed? Did you have some sort of event that led your provider to order it?

Best regards,
DDM

It is I who should apologize, as I should have read your question more closely!

No event precipitated my request; rather, about 4 years post-treatment, I decided to research the possible effects of the radiotherapy on adjacent tissues. The carotid artery & the thyroid were two areas showing potential negative consequences from the treatment. Being a proactive type, I asked my GP for an ultrasound.

DSD

 

[Duke Dive Medicine]

It is I who should apologize, as I should have read your question more closely!

No event precipitated my request; rather, about 4 years post-treatment, I decided to research the possible effects of the radiotherapy on adjacent tissues. The carotid artery & the thyroid were two areas showing potential negative consequences from the treatment. Being a proactive type, I asked my GP for an ultrasound.

DSD

Thanks for the details, and no worries! I just wanted to verify that you hadn't had some sort of central neurological event that precipitated the ultrasound study.

As you probably know, the carotid arteries are sort of nestled in the notch in the neck between the trachea and the sternocleidomastoid muscles. Of course the neck seal does just that, it seals, but the tightness is going to vary based on the anatomy of the neck. If it's so tight that it's exerting direct pressure on your carotid arteries, you're going to feel like it's choking you and your face will turn interesting colors.

There is individual variation in plaque stability, so you may want to frame the conversation with your interventional cardiologist around how sensitive your individual plaque would be to the mild pressure that your neck seal would exert. And, if you're considering a stent procedure, ask the same question about the stent.

Best regards,
DDM

 

[DeepSeaDan]

Thanks for the details, and no worries! I just wanted to verify that you hadn't had some sort of central neurological event that precipitated the ultrasound study.

As you probably know, the carotid arteries are sort of nestled in the notch in the neck between the trachea and the sternocleidomastoid muscles. Of course the neck seal does just that, it seals, but the tightness is going to vary based on the anatomy of the neck. If it's so tight that it's exerting direct pressure on your carotid arteries, you're going to feel like it's choking you and your face will turn interesting colors.

There is individual variation in plaque stability, so you may want to frame the conversation with your interventional cardiologist around how sensitive your individual plaque would be to the mild pressure that your neck seal would exert. And, if you're considering a stent procedure, ask the same question about the stent.

Best regards,
DDM

Good advice - I shall take it. Much appreciated!

DSD