aymptomatic carotid artery stenosis

A

anon1368

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I have a history of head/neck radiation more than 10 years ago. At my last routine physical a couple of weeks ago, my primary care doctor noted carotid bruits on both sides. Subsequent workup demonstrated 90% carotid stenosis on one side and 60% on the other, a not-uncommon side effect of head/neck radiation. Completely asymptomatic, no history of fainting, TIA, amaurosis fugax, or any other neurologic abnormalities or symptoms. He has put me on low-dose aspirin while we ponder and investigate treatment options going forward. The diagnosis coding is only Bilateral Carotid Stenosis

I have pondered going Basic Med for awhile, but now, obviously, I am much more interested and plan on doing so. My doctor has indicated that he has no problem signing off on the Basic Med CMEC.

Observations or comments? I don't want to violate any FARs, nor do I want to be duplicitous, but I can't find anything that indicates that asymptomatic carotid stenosis with no history of neurologic events would prevent me from legally flying under Basic Med.
 
Here's how I look at it. You can go immediately to Basic Med for the cost of a physician visit and the small amount of time it takes to take the free quiz. Then you're good to go on your own judgment without any FAA oversight. The management of the carotid stenosis is entirely in your hands with your own doctor, and can be guided by what is medically best rather than what the FAA standards are, which can be very extensive and not covered by your insurance. (Ask me how I know.)

Or you can self ground. (Presumably what you know already is sufficient for you to know that you would not be able to "meet the qualifications of the medical certificate"). Then you may possibly spend thousands of dollars for extensive testing then wait for three to six months or more for CAMI approval. Now you're stuck with your medical care in the hands of the FAA with no option to fly under Basic Med - perhaps permanently if the obstacles become insurmountable.

With the first option nothing prevents you from operating under Basic Med while still evaluating an option for your medical condition, as long as you know that you can "operate the aircraft in a safe manner".
 
I'm honestly not even sure that a diagnosis of carotid stenosis is disqualifying for a Class 3 (and don't want to ask my AME), but what I don't want to do is put myself down a path where I fail a Class 3 and then would be ineligible for Basic Med, not to mention being enmeshed in the huge hassles that the FAA medical branch is noted for.

I appreciate the input, thank you.
 
anon1368 said:
I'm honestly not even sure that a diagnosis of carotid stenosis is disqualifying for a Class 3 (and don't want to ask my AME), but what I don't want to do is put myself down a path where I fail a Class 3 and then would be ineligible for Basic Med, not to mention being enmeshed in the huge hassles that the FAA medical branch is noted for.

I appreciate the input, thank you.
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Well, you CAN ask your AME, as long as you do it outside the MedXpress pathway. But again, if he flat out tells you that you won't pass the exam until you (fill in the blanks . . . ) then now you KNOW you have a condition that makes you unable to meet the requirements according to 61.53. That's why so many airman have wisely chosen to seek advice anonymously here and get it from someone who knows the whole specific process well (which is certainly not me).

Carotid stenosis used to require a Special Issuance, but I do know that the FAA was at one point considering exempting that diagnosis. However, that still doesn't mean that when you report it you won't have to produce a lot of documentation that it doesn't pose a significant risk of incapacitation - and that may be on a case-by-case basis.
 
the 90% stenosis will likely be 100% soon and will leave you with a severe stroke. best you get your carotids repaired.
 
lbfjrmd said:
the 90% stenosis will likely be 100% soon and will leave you with a severe stroke. best you get your carotids repaired.
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And that (stroke/TIA) will require an SI before going basic med.

I can see going to BasicMed now while fixing the arteries.
 
TCABM said:
I can see going to BasicMed now while fixing the arteries.
Click to expand...

Yeah that's the plan, of course. Class 3 expires in a year. I'd like to have Basic Med up and running by then because options, and I don't want to have to deal with the FAA's interpretation of the consequences of the revascularization...I'd rather keep it just between my PCP and me. Of course, if there are neurological complications either before or after the stenting then that will be moot.
 
Get on Basic Med. If that meets your needs, fantastic. If it doesn't, then once you're set there, have a consult with a great Senior AME who lives to keep airmen flying and see what he says about a third class. In the meantime, health first.
 
Lindberg said:
Get on Basic Med. If that meets your needs, fantastic. If it doesn't, then once you're set there, have a consult with a great Senior AME who lives to keep airmen flying and see what he says about a third class. In the meantime, health first.
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Completed the Basic Med stuff yesterday, Class 3 expires in a year. Should be good to go. I'll decide then whether or not to try for a new Class 3. Right now, doesn't seem to be worth the risk.
 
I have no advice concerning basic med vs third class- but I’ll endorse/amplify what lbfjrmd and Lindbergh said-
Do not sit on a 90% carotid stenosis. You already have tangible signs of altered blood flow- the bruits.
Act aggressively. The warning signs are there of danger to your most vital organ.
 
SFDukie said:
I have no advice concerning basic med vs third class- but I’ll endorse/amplify what lbfjrmd and Lindbergh said-
Do not sit on a 90% carotid stenosis. You already have tangible signs of altered blood flow- the bruits.
Act aggressively. The warning signs are there of danger to your most vital organ.
Click to expand...

Thanks for your concern. I'm very knowledgeable about carotid occlusive disease and have that problem well-in-hand. Basic Med...not so much, and this thread has been helpful in that regard.
 
hope u r not like my patient that swore 'melaleuca supplements' would cure his carotid stenosis!
 
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