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The Europeans in particular have found that biomarkers (blood tests)
predict atheroembolic events in patients with carotid bifurcation
atherosclerosis and I think that this may be added to clinical practice.
Joe
 
 
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On 10/20/12 8:51 PM, "K. Beach" <[log in to unmask]> wrote:

>
>Dear Bill,
>
>Yes, this is the same Moniz that developed X-ray angiographic contrast
>agents for cerebral studies, and the frontal lobotomy
>(I'd rather have a bottle in front of me than a frontal lobotomy).
>He received the Nobel Prize for the Frontal Lobotomy in 1949, just a year
>prior to the introduction of the first drugs for the treatment of mental
>illness.
>
>Regarding Doppler vs Angioigraphy.
>What we want to know is which patients will stroke from carotid
>atheroembolic events (not thromboembolic).
>Angiography does as poorly in predicting carotid atheroembolic stoke as
>the discarded Oculoplethysmography methods, but identifies different
>patients at risk.  So, the correlation between anatomy and physiology
>does 
>not completely resolve the question of who is at risk of stroke.
>That is why some talk about vulnerable plaque, which maybe neither
>Doppler 
>nor Angiography identify.
>Logic does not always lead to truth.
>
>Kirk
>
>
>On Sat, 20 Oct 2012, Bill Johnson wrote:
>
>> Bill Johnson, Port Townsend, WA.
>>  
>> Kirk, Thanks as always for staying on this list and your continuing
>>contributions. 
>>  
>> Egaz Moniz?  The same doctor that proposed lobotomy for mental illness?
>> (Mine never worked. but how would I know?)  ;-)
>>  
>> I do not entirely think Anatomy/Velocity Correlation is "futile" but
>>would suggest that we still try to look at flow with multiple vectors
>> and assume we can "pick" the correct angle to calculate velocities.
>>What ever happened to the "infinitely gated Doppler"?  Not sure that
>> would help, but I have always been suspicious of spectrum analysis, and
>>probably have less confidence than most.  I have also been
>> suspicious regarding non-economic "gold standards".   Ultrasound and
>>angiography are such very different exams, that I am not very much
>> surprised that correlation is elusive.
>>  
>> I am not entirely a pessimist though, and do believe noninvasive
>>vascular exams do provide useful information.  As you wrote; "...Doppler
>> velocity criteria have been successfully used to classify the severity
>>of stenosis...) Thanks again.
>> 
>> On Sat, Oct 20, 2012 at 9:01 AM, K. Beach <[log in to unmask]>
>>wrote:
>>
>>       Dear Ruth,
>>
>>       The question of how to classify carotid stenosis has been vexing
>>us since Egaz Moniz.
>>       Unfortunately, Anatomy/Velocity Correlation is futile, in spite
>>of our confidence to the contrary.
>>       ----------------------
>>       Beach KW, Leotta DF, Zierler RE., Carotid Doppler velocity
>>measurements and anatomic stenosis: correlation is futile., Vasc
>>       Endovascular Surg. 2012 Aug;46(6):466-74.
>>
>>       from the Ultrasound Reading Center and the D.E. Strandness Jr.
>>Vascular Laboratory at University of Washington Medical Center,
>>       University of Washington, Seattle, WA 98195, USA.
>>
>>       Abstract
>>       BACKGROUND: Duplex ultrasound with Doppler velocimetry is widely
>>used to evaluate the presence and severity of internal
>>       carotid artery stenosis; however, a variety of velocity criteria
>>are currently being applied to classify stenosis severity.
>>       The purpose of this study is to compare published Doppler
>>velocity measurements to the severity of internal carotid artery
>>       stenosis as assessed by x-ray angiography in order to clarify the
>>relationship between these 2 widely used approaches to
>>       assess carotid artery disease.
>>
>>       METHODS: Scatter diagrams or "scattergrams" of correlations
>>between Doppler velocity measurements and stenosis severity as
>>       assessed by x-ray contrast angiography were obtained from
>>published articles for native and stented internal carotid arteries.
>>       The scattergrams were graphically digitized, combined, and
>>segmented into categories bounded by 50% and 70% diameter
>>       reduction. These data were combined and divided into 3 sets
>>representing different velocity parameters: (1) peak systolic
>>       velocity, (2) end-diastolic velocity, and (3) the internal
>>carotid artery to common carotid artery peak systolic velocity
>>       ratio. The horizontal axis of each scattergram was transformed to
>>form a cumulative distribution function, and thresholds were
>>       established for the stenosis categories to assess data
>>variability.
>>
>>       RESULTS: Nineteen publications with 22 data sets were identified
>>and included in this analysis. Wide variability was apparent
>>       between all 3 velocity parameters and angiographic percent
>>stenosis. The optimal peak systolic velocity thresholds for
>>       stenosis in stented carotid arteries were higher than those for
>>native carotid arteries. Within each category of stenosis, the
>>       variability of all 3 velocity parameters was significantly lower
>>in stented arteries than in native arteries.
>>
>>       CONCLUSION: Although Doppler velocity criteria have been
>>successfully used to classify the severity of stenosis in both native
>>       and stented carotid arteries, the relationship to angiographic
>>stenosis contains significant variability. This analysis of
>>       published studies suggests that further refinements in Doppler
>>velocity criteria will not lead to improved correlation with
>>       carotid stenosis as demonstrated by angiography.
>> 
>>
>>       ------------------------
>>       Kirk
>>       -----------------------
>> 
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>
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