Cerebrovascular disease is a potential precursor to transient ischemic attack (TIA), stroke, or other neurological disorders that could lead to incapacitation. If disease is found in the carotid artery that supplies blood to the brain, other blockage may be present in the peripheral circulation to the lower extremities or other internal organs, particularly the heart.
The FAA can qualify applicants who have minor cerebrovascular blockage that causes no symptoms. Recertification is also possible after corrective surgery, called an "endarterectomy," to remove significant blockage from the carotid artery. Usually, surgery is delayed until the disease progresses to the point of causing near-total obstruction of the carotid circulation, or when symptoms occur. These symptoms often include disturbances of consciousness, vision problems, facial palsy, decrease in arm and leg strength, or speech abnormalities, all of which could indicate that a stroke is imminent or has already occurred.
Carotid artery stenting is now being done as an alternative to endarterectomy in some cases. Following either a stent procedure or the more invasive endarterectomy, the FAA requires a three-month recovery and stabilization period before considering recertification. If evidence reveals that a stroke or TIA has occurred, a 24-month recovery and stabilization period is usually required.
The presence of cerebrovascular disease may be an indication of underlying coronary artery disease. For that reason, the FAA requires a cardiovascular evaluation to be submitted for medical certification consideration. In addition, hospital records that include the admission history and physical, operative report, and discharge summary are required. Also, a post-operative carotid Doppler ultrasound study will be required. Post-operative carotid arteriogram might be necessary in some cases.
See also: Cardiovascular Evaluation Specifications
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Updated December 4, 2015