I thought I'd chime in my 2 cents worth here, as this is a topic that I find quite interesting. I am also from the generation that was taught that ulcerative plaque cannot be diagnosed by US. I think with improved gray scale, color Doppler and power Doppler, this belief is in transition. Zwiebel describes ulcerative plaque characterization in his 5th edition of Introduction to Vascular Ultrasonography (p. 163-4, I believe - it's my 'go to' resource).  After studying these pages in his book, I became more suspicious of some plaques that came my way.  In the past few years,  3-4 patients that had plaques as described by Zwiebel proceeded to CEA (at least 1 based strictly off the duplex), and all had ulcerative plaque.  It takes just a few more minutes to interrogate the site in question, in a few different approaches, but it is worth the effort. One surgeon that I currently work with believes US is the most sensitive (testing) modality for ulcerative plaque.

Again, interesting topic - and I suspect we will be seeing more validation by duplex in the future.

Marge

Marguerite Marlowe, RN, RVT
Technical Director
Vascular Lab
Medical University of South Carolina

(formerly, Marguerite Cappuccio - recently took maiden name back)

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Bill Schroedter
Sent: Sunday, November 04, 2018 11:43 AM
To: [log in to unmask]
Subject: Carotid stenosis question


CAUTION: External
So I got into a bit of a "discussion" with a vascular surgeon about identification of carotid plaque ulceration. He suggested that the identification of ulceration in a symptomatic patient would benefit from endarterectomy regardless the severity of the stenosis. To his defense, he offered several papers ex: (CT and US in the Study of Ulcerated Carotid Plaque Compared with Surgical Results - Am J Neuroradiol 28:1061-66 July 2007)

My argument as not that you could not find a ulceration (although I'm not completely convinced, our past studies with surgical comparison showed no method was all that great. Plus I'm not really sure our angio/CTA/US definition of ulceration is completely accurate). But as far I know, severity of stenosis is the only finding validated that correlates with the risk of symptoms and/or stroke.  My search (albeit not exhaustive) has not really shown otherwise.  Can anybody direct me to a source that that risk of stroke during endarterectomy (or angioplasty / stent) to repair a vessel with an ulcerated plaque and a diameter reduction of say 40 or 50% is less than best medical management?

Dr. Beach - you still out there?
Regards,
Bill

William B Schroedter, BS, RVT, RPhS, FSVU
4120 Woodmere Park Blvd
Suite 8B
Venice, Florida  34293
www.virtualvascularlab.com<http://www.virtualvascularlab.com>
www.virtualveincenter.com<http://www.virtualveincenter.com>

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