My humble opinion:
A hemodynamically significant stenosis (unless it's just a string sign) will have an elevation of velocities and associated post-stenotic turbulence. Is that documented in the study?
Since the ECA only supplies the brain if it has been recruited as a collateral pathway I would think that a prudent measure might be to evaluate periorbital flow (using evocative compressions of the facial artery and its branches - resembles the Vulcan Mind Probe grip - do you remember Spock did this to an entity and determined that it was in extreme pain? - but I digress) and perhaps due a full TCD exam to evaluate intracranial collateralization.
Has anyone read anything describing TIA or CVA from a high grade ECA stenosis? A physician has stated to me that you can get TIA's or CVA's from an ECA with high grade stenosis. ( Right ICA peak 116, Left ICA peak 76 cm/sec) Need some lit to support his claim. I wanted him to change his report from claiming "critical ECA stenosis, " because most PCP's would send that patient to a vascular surgeon based on that report. Thanks in advance for your help! Barb
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