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UVMFLOWNET  April 2009

UVMFLOWNET April 2009

Subject:

Re: The Mysterious Disappearing Plaque

From:

Doug Marcum <[log in to unmask]>

Reply-To:

UVM Flownet <[log in to unmask]>

Date:

Thu, 2 Apr 2009 11:15:19 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (318 lines)

So Kelly

Are you optioning for PTA and stent or CEA?   Lol

D

Doug Marcum RDMS,RDCS,RVT(APS)
Advanced Ultrasound Consultants
321.231.2191
www.advancedusconsultants.com
Sent from my iPhone

On Apr 2, 2009, at 11:02 AM, "Estes, Kelly M"  
<[log in to unmask]> wrote:

> Not to beat a dead horse, but I just scanned my own LICA with and
> without pressure and I obtained a PSV of 104 cm/s with no spectral
> broadening without probe pressure and with pressure it measures 141  
> cm/s
> with spectral broadening.
>
> Kelly Estes, RVT, RDCS, RDMS
> 704-316-5100
>
>
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Jeff
> Stanley
> Sent: Thursday, April 02, 2009 9:38 AM
> To: [log in to unmask]
> Subject: Re: The Mysterious Disappearing Plaque
>
> I'm not really convinced at the "increased transducer pressure"  
> concept.
> I don't see the same sonographer (Don) doing a carotid duplex a week
> apart with that much difference in probe pressure.   I can see
> difference in pressure between different sonographers maybe.  Unless  
> the
> ER, ICU, CCU, and recovery room all just called needing STAT studies,
> that may cause me to exert a little more pressure.....
>
> Jeff
>
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Don
> Ridgway
> Sent: Wednesday, April 01, 2009 10:27 PM
> To: [log in to unmask]
> Subject: Re: The Mysterious Disappearing Plaque
>
> And, at the risk of overexposure here, I had a couple of people do my
> ICA with gradually increasing pressure, both lateral and anterior
> approaches, and couldn't get an appreciable velocity change even  
> when it
> was very painful indeed. I have trouble believing that excess pressure
> was the issue. It occurs to me that maybe the edge of the probe could
> dig in and create more focal pressure, but then that wouldn't be where
> the sample volume lies.
>
> Don
>
>
>
>
>
>
> -----Original Message-----
> From: UVM Flownet on behalf of Don Ridgway
> Sent: Wed 4/1/2009 6:06 PM
> To: [log in to unmask]
> Subject: Re: The Mysterious Disappearing Plaque
>
>
> I'm not persuaded yet. I have to get back to that office to try to
> scrutinize the gray-scale images more carefully, but my recollection  
> is
> that it looked different from one study to the next. And I'm not  
> married
> to particular numbers. Stay tuned.
>
> Don Ridgway
>
>
>
>
>
> ________________________________
>
> From: UVM Flownet on behalf of [log in to unmask]
> Sent: Wed 4/1/2009 3:31 PM
> To: [log in to unmask]
> Subject: Re: The Mysterious Disappearing Plaque
>
>
>
> A colleague and I did a little experiment today scanning a normal
> carotid and applying slightly more pressure with the transducer at
> exactly the same spot. we got the velocity to increase from 63 to 108
> cm/s.... so as someone suggested in this thread, external pressure
> itself could have accounted for the differences. But let's not forget
> here that inter-observer and inter-device variability could have also
> played a role, AND that the velocities may have also been taken at
> slightly different locations. So the mystery of the disappearing  
> plaque
> is solved.
>
> Nathalie
> NSU
>
>
> Quoting Kelly <[log in to unmask]>:
>
>> One week apart? I seriously doubt that there has been 30% regression
>> from medications with one week between the exams. I hear you on the
>> miracle medications. Sign me up for the one your patient is taking!
>>
>> -----Original Message-----
>> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Don
>> Ridgway
>> Sent: Tuesday, March 31, 2009 4:21 PM
>> To: [log in to unmask]
>> Subject: Re: The Mysterious Disappearing Plaque
>>
>> I don't know enough to have an opinion, but I have an opinion: I'm
>> willing to believe that there could be modest regression, but not a
>> 30% reduction in stenosis. I'd be glad to find I'm wrong, as I'm  
>> going
>
>> to need whatever miracle plaque-reducers come along in the next ten
> years.
>>
>> Don
>>
>>
>>
>>
>> -----Original Message-----
>> From: UVM Flownet on behalf of Melma Evangelista
>> Sent: Tue 3/31/2009 12:56 PM
>> To: [log in to unmask]
>> Subject: Re: The Mysterious Disappearing Plaque
>>
>> Hi Don,
>> I read some articles about plaque regression after long years of
>> taking lipid lowering drugs.
>> What is your opinion about this.
>> Thanks,
>> jean
>>
>>>>> Don Ridgway <[log in to unmask]> 3/31/2009 3:30 PM >>>
>> I like this possibility very much. I'm going to try to go back to see
>> the study again in an effort to scrutinize the gray scale images more
> closely.
>>
>> To respond to Kristy Peeler: no, no symptoms that anyone can elicit
>> information about.
>>
>> Other suggestions: Pushing hard enough to cause stricture in the
>> artery seems theoretically possible, but shoot, you'd have to be
>> leaning very hard indeed. I demonstrate that possibility to students
>> often at the PT or AT arteries, but they're just a few mm down.
>> Difference with head-turning, that seems possible. I can't test it on
> this one, though.
>>
>>
>> Thanks for the input, all.
>>
>> Don Ridgway
>>
>>
>>
>>
>>
>> -----Original Message-----
>> From: UVM Flownet on behalf of Bill Schroedter
>> Sent: Mon 3/30/2009 5:59 PM
>> To: [log in to unmask]
>> Subject: Re: The Mysterious Disappearing Plaque
>>
>> Hi Don, Did the patient have any sympotms? Give us a bit on the
>> patient's history. Also what did the plaque look like?  On a couple  
>> of
>
>> occasions but certainly a very rarely, we have seen a sudden, fairly
>> dramatic change in the degree of stenosis. Imagine a plaque that
>> ruptures with resultant intraplaque hemorrhage that, in fairly short
>> order, bulges the intima into the lumen increasing the stenosis. If  
>> it
>
>> does not reupture the intima, he may remain asymptomatic. Or a
>> hemorrhage that is subacute that begins to heal and the degree of
>> stenosis thus diminishes. I have no idea if that is what is going on
> but a scenario to consider.
>>
>> Bill Schroedter
>> Venice, Fl
>>
>>  _____
>>
>> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Don
>> Ridgway
>> Sent: Thursday, March 26, 2009 3:08 PM
>> To: [log in to unmask]
>> Subject: The Mysterious Disappearing Plaque
>>
>>
>>
>>
>> [This may be a duplicate-had trouble getting the first one through.]
>>
>>
>>
>>
>> Okay, friends:
>>
>> I was asked to look at two carotid studies on one patient in docs'
>> offices a week apart. The first looked techincally okay, and I agreed
>> with the flow character and velocities pointing to around 70% LICA.
>> Then I looked at the second one, and agreed with the call of 40-50%.
>> I'm assuming that there must have been something wrong with the first
>> study. Just now the first doc got the patient back in so I could  
>> scan,
>
>> and it seems again reasonable at 40-50%.
>>
>> Then I looked at the original study, and could find nothing
>> essentially wrong with it: the color flow was scrambled, quite
>> different from the flow character I had just seen, and the spectral
>> was decidedly stenotic and turbulent in character-leave aside the
>> actual velocities, with EDV around 140. I might have quibbled  
>> slightly
>
>> with the angle-correction, but not greatly, so give it even a leeway
>> of 40 cm/sec and 70% seems like an okay call.
>>
>> Difference in cardiac state? I don't think so. Other flow character
>> (CCA,
>> ECA) was comparable.
>>
>> Different patient? I don't think so. The right side looked the same  
>> in
>
>> all studies.
>>
>> Could a chunk have broken off and traveled? Without the patient
>> stroking big time? You tell me. Seems unlikely.
>>
>> So my explanation to the first doc was that the patient obviously
>> sneaked off for some chelation therapy in the week between the
>> studies, and it only worked on the left side.
>>
>> Can anyone share a similar experience? Or an explanation?
>>
>> Thanks,
>>
>>
>> Don Ridgway
>>
>>
>>
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