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Hi , In  agreement with Dr Schneider we only comment on an ECA if there is
a stenosis with velocities elevated and possibly contributing to a n
audible bruit.  Too much confusion with the referring. Also make sure to
confirm it is an ECA with Temporal tap ,
My two cents, Denise

On Wednesday, October 21, 2015, Audrey Fleming <[log in to unmask]>
wrote:

> 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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