Richard, Interesting case. We have seen only a very few cases that we
     felt there was truly a plaque regression but there are a few reports
     to that effect. It would seem feasible that a significant change in
     cardiac status could alter velocities. Do you measure the plaque? Is
     the velocity the only thing that is different? Did the disease/plaque
     measure or simply "look" any different? This is a case that I would
     tend to hang my hat on the image to say whether or not there was any
     change. While velocity is the proven method to assess disease severity
     it is an indirect method. I will quote Holec's first rule of duplex
     imaging - "reconcile all Doppler changes with imaging!"

     Bill Schroedter
     Venice,Fl.


______________________________ Reply Separator _________________________________
Subject: carotid dilema
Author: UVM Flownet <[log in to unmask]> at Internet
Date: 12/18/98 10:41 AM


Can anyone offer an explanation? This is the scenario. (Outpatient without
much history provided)
1. 67 yr old male with history of dizziness, HTN, diabetes, obesity and
intermittent claudication. Patient has hx of smoking, (1-2ppd) but quit for
seven years now.
2. Lt. sided bruit present.
3.Carotid Duplex performed 8-26-97 revealed a 60-80% Lt ICA stenosis with
bilateral
 diffuse atherosclerotic changes in all vessels . ( velocites in the Lt. ICA
is 168cm/sec peak systolic and 51 cm/sec EDV.)
4. Another Carotrid Duplex was performed 9-15-98 for comparison. (symptoms the
same, no changes in patient status) Velocities in the Lt. ICA are 104 cm/sec
peak systolic and 30 cm/sec EDV. It was interpreted as atherosclerotic changes
without hemodynamically significant stenosis.

Question is, "Could a cholesterol-reducing drug cause some softening and
redistribution of plaque formation causing a lower velocity? (Of course I
don't want to ask the manufacturer of the drug because I have a feeling what
his answer would be, HAHA!) What I would like to know is that in the meantime
from that last ultrasound to today, the patient was admitted since October
1998 with a massive coronary and had apparent heart disease which may have
been present all along and increased in severity from (8-27-97 to date of
coronary 10-?-98.) Our lab believes that a poor cardiac output and ischemic
heart be the cause for the decreased velocity.
Did anyone have an experience like this or can offer info, articles,
explaining ths scenario?

RichardG. Brebner, BS, RDMS, RDCS, RVT
Ultrasound Services, Inc
AIUM, ICAVL, ICAEL Accreditation granted.
[log in to unmask]