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![Carotid duplex ultrasound showing a 50% left carotid artery stenosis (internal carotid artery peak systolic velocity [ICA PSV] 113 cm/sec, ICA end diastolic velocity [EDV] 43 cm/sec, ICA/ common carotid artery [CCA] PSV ratio 1.6), a mixed echogenic and echolucent plaque composition and an ulcerated surface](profile/Enrico-Sbarigia/publication/51048372/figure/fig1/AS:394362832867331@1471034834762/Carotid-duplex-ultrasound-showing-a-50-left-carotid-artery-stenosis-internal-carotid.png)
Carotid duplex ultrasound showing a 50% left carotid artery stenosis (internal carotid artery peak systolic velocity [ICA PSV] 113 cm/sec, ICA end diastolic velocity [EDV] 43 cm/sec, ICA/ common carotid artery [CCA] PSV ratio 1.6), a mixed echogenic and echolucent plaque composition and an ulcerated surface
Source publication
Atheromatous plaques are dynamic structures undergoing continuous remodeling. Duplex ultrasound is now an accepted technique to classify the severity of arterial stenoses. It gives information about the ultrasonic echogenicity of tissue, the plaque surface and the velocity of blood flowing through vessels with the latest equipment. We report the ca...
Context in source publication
Context 1
... thousand UI per day of low-molecular-weight heparin (enoxaparin) was administered, along with his scheduled antiplatelet (ASA 100 mg per day), antihypertensive (enala- pril 10 mg per day), antidiabetic (metformin 500 mg twice a day) and statin (atorvastatin 40 mg per day) therapy. During hospitalization, he underwent transesophageal echo- cardiography, aortic arch and supra-aortic vessel CT angio- graphy, and carotid duplex ultrasound to detect the source of embolization, and a 50% left carotid artery stenosis was encountered (internal carotid artery peak systolic velocity [ 11 (GSM) score of 47.5 (mean value calculated in two longitudi- nal images with maximum plaque area, using two reference points to set the gray scale from 0 or black = blood to 255 or white = adventitia) and an ulcerated surface (Figure 1). The size of the brain infarct was subsequently evaluated by contrast-enhanced CT and was found to be 10 mm in dia- meter in the left periventricular middle cerebral artery area. ...
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Citations
Carotid endarterectomy (CEA) has been shown to reduce the risk of stroke and death in symptomatic patients with carotid occlusive disease. However there is controversy on the timing of surgery in patients who suffer a stroke. Historically, in the literature it has suggested that the optimal timing to perform CEA was approximately 6 weeks after an acute stroke. This conclusion was reached due to the high perioperative morbidity and mortality if CEA was performed too early. Notwithstanding, this approach has now been called into question because of indisputable evidence that a) the early risk of stroke after a patient suffers a transient ischemic attack (TIA)/minor stroke is significantly higher than previously taught, and b) the long term benefit of surgey diminishes rapidly following onset of the index event. This article discusses 20th Century literature and focuses on more recent 21st Century literature as regards the timing of CEA after acute stroke.
