Whole point of CREST II



Dr Jason Roberts 
(C) 954-801-2496
(E) [log in to unmask]
Sent from my mobile phone, please excuse any typos 

-------- Original message --------
From: Brian Sapp <[log in to unmask]>
Date: 11/4/18 1:27 PM (GMT-05:00)
To: [log in to unmask]
Subject: Re: Carotid stenosis question

Bill,

This is a great topic.  I don’t know of any papers but had an interesting experience 10-12 years ago.   I had a patient who had a TIA and on the ultrasound the velocities were just over 50%, however the texture of the plaque was very dark and sponge (that isn’t a term). I have never seen another plaque like this. The ordering physician and radiologist both trusted me and sent to a Vascular surgeon.  The surgeon ordered a MRA and didn’t intervene because it was 50%.  The patient ended up having 13 more TIA’s and a CTA before they finally performed endarterectomy.  The plaque was described as gooey.  

Is the patient in question symptomatic? If they are asymptomatic with an ulcer I would think that aggressive medical treatment would be the way to go. If they are symptomatic then treatment would be indicated.  JMHO. 

Brian Sapp RVT, RPhS
Registeredvascular.net
404-667-9417
800-385-2790

On Nov 4, 2018, at 11:42 AM, Bill Schroedter <[log in to unmask]> wrote:

So I got into a bit of a “discussion” with a vascular surgeon about identification of carotid plaque ulceration. He suggested that the identification of ulceration in a symptomatic patient would benefit from endarterectomy regardless the severity of the stenosis. To his defense, he offered several papers ex: (CT and US in the Study of Ulcerated Carotid Plaque Compared with Surgical Results - Am J Neuroradiol 28:1061-66 July 2007)

 

My argument as not that you could not find a ulceration (although I’m not completely convinced, our past studies with surgical comparison showed no method was all that great. Plus I’m not really sure our angio/CTA/US definition of ulceration is completely accurate). But as far I know, severity of stenosis is the only finding validated that correlates with the risk of symptoms and/or stroke.  My search (albeit not exhaustive) has not really shown otherwise.  Can anybody direct me to a source that that risk of stroke during endarterectomy (or angioplasty / stent) to repair a vessel with an ulcerated plaque and a diameter reduction of say 40 or 50% is less than best medical management?   

 

Dr. Beach – you still out there?

Regards,

Bill

 

William B Schroedter, BS, RVT, RPhS, FSVU

4120 Woodmere Park Blvd

Suite 8B

Venice, Florida  34293

www.virtualvascularlab.com

www.virtualveincenter.com

 

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