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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