I am one of the few who hate the 1-49% stenosis. The argument has always been anything under 50% is not hemodynamically significant and that is true. There are many labs who describe and provide statements that cue in the internal medicine physician on the need to follow up, however there just as many or more that just leave a basic statement of interpretation such as: No hemodynamically significant stenosis in the right internal carotid artery 1-49%. The danger in this is a 40% stenosis is not significant hemodynamically but if found in a 47 year old man with a strong family history of disease is very significant. For this reason I still advocate 1-20, 21-49 as it provides enough room for a Sonographer to provide an understandable interpretation for both the vascular professional but also the internal medicine physician. Just my humble observation. The IMT criteria we used with a 10 mm segment taken distal 1 cm. of the distal CCA: normal <0.80 mm.,
Moderate 0.8-1.5 mm (1.7 Times increased risk of MI or CVA) and severe >1.5 mm (3.5 times risk of MI or CVA) as measured by IMT package and not manually. Anything over 2.5 mm and having characteristics of plaque was considered plaque. We
Brian Sapp, RVT, RPhS
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> On Oct 22, 2015, at 11:02 AM, Christina Lewis <[log in to unmask]> wrote:
> I would argue that an annual check-up can relieve a patient's anxiety, because now they are being periodically evaluated, which is better for many patients than the great "not knowing." And for those that do worry about it, I've found it very helpful to reframe it for them in that way.
> To address the original query, we don't measure IMT. So we wouldn't consider a minimally thickened wall to be a <50% stenosis. I do agree that there are a lot of <50% stenoses that don't need to be followed every year, but I also recognize that there are limitations to plaque evaluation by ultrasound. I certainly wouldn't want to be the one that wrote a preliminary report that missed an ulcerated plaque hidden by plaque shadowing and have that person put into five-year recalls and show up two years later with a stroke. We look at these so often, that we think we KNOW what kind of plaque we are looking at, but the data doesn't seem to support that. For that reason, I'm pretty comfortable with performing annual check-ups on carotid patients. There are a lot of other things that can really get me going, but this isn't one of them.
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