I guess my first question is, "does it matter?" 0-49% or 1-49% is still below the threshold of intervention by almost everyone. Unless there is obvious ulcerative plaque with associated clinical findings, 0-49% is a moot point. If the plaque is appraching that 50% then a note can be made as such and suggest clinical correlation.

I would never call a "stenosis" with any finding of 1-49%. It is not hemodynamically significant and certainly not op worthy ( understanding there may be rare instances of unusual clinical circumstances). 

I am always amazed at the patient who returns year after year for their annual carotid exam because someone called a stenosis of 5%. Now that STENOSIS!!!!! is followed every year until death. Hmmmm, let's all wonder why there are more and more cuts in payment.

Just my 1 cent worth of thought for the day.


From: "Schneider, Joseph MD" <[log in to unmask]>
To: [log in to unmask]
Sent: Wednesday, October 21, 2015 9:38 AM
Subject: carotid plaque standards


 
 
 
Ladies and gentlemen:
 
I received the following query from a colleague and would appreciate hearing what people think about this
 
Simple question for you- we are revising our vascular lab protocols and got into a debate about what actually defines the presence of plaque in the extracranial carotid system (which would mean the difference between calling the artery normal versus having 1-49% stenosis).  Some techs say they were taught that if the IMT is > 1mm that they should consider this to indicate the presence of plaque, whereas others are using 3 mm as a cutoff- I am finding that there is a real issue with techs and reading physicians ‘eyeballing’ the carotid to determine plaque presence or not in cases where the artery wall is maybe a bit thick, but there is no real plaque (calcification, etc.) and I am wondering if we are over calling the presence of 1-49% stenosis in normal arteries.  What is your understanding of the definition of plaque presence in the carotid when it comes to these cases of mildly thickened wall with no convincing plaque? 
 
Incidentally, my personal answer to her was as follows:
 
I can tell you that we are set up to do IMT, but our Cardiologists have said that they think the bloom is off the rose for IMT and they don’t ask for it. I look for plaque primarily on the B-mode transverse loops and if I see anything I will call it <50% assuming there are no elevated velocities.  As I recall the Grant articles about “consensus” standards don’t specifically address this and I’m not aware of any definitive literature on the topic.  I will ask the Flownet (primarily sonographers) and I will ask John Gocke and Greg Moneta, both of them co-authors on the Grant papers, and get back to you. 
 
 
Thanks in advance
 
Joe
 



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