Do not routinely check a carotid stenosis of less than 50% every year with Color Doppler Ultrasound.
The so-called “low-grade” stenoses are largely represented (up to 90%) in observational series of “first examinations”. In these, the progression of the stenosis has been calculated in around 7% of cases. The “uncritical” and “serial” prescription of a one-year follow-up by Color Doppler Ultrasound of a carotid stenosis of less than 50% does not bring clinical benefits in terms of stroke reduction while the effects of the overuse of the method are well known. Defining the timing of the Color Doppler Ultrasound follow-up of carotid stenoses of less than 50% requires individualized assessment of the global cardiovascular risk profile (including achievement of secondary prevention targets and degree of adherence to therapy) and additional plaque characterization (e.g. echogenicity, homogeneity, surface area, temporal progression of the stricture) as well as the clinical history.
Sources
1. Aboyans V, Ricco J-B, Bartelink M-LEL, et al. ESC Scientific Document Group. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39: 763–816.
2. Kakkos SK, Nicolaides AN, Charalambous I, et al. Predictors and clinical significance of progression or regression of asymptomatic carotid stenosis. J Vasc Surg 2014; 59: 956-67.
3. Bennet GM, Bluth EI, Larson ML, Luo Q. Recommendations for low-grade carotidstenosi follow-upbased on a single-institution data base. J UltrasoundMed 2018; 37: 439–445.
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PDFAttention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.
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