carotid artery ultrasound

[BoodaGazelle]

I recently switched doctors. As part of my overall physical, my cholesterol came back high, which I already knew (it runs very high in my family). I had previously been on Crestor (statin) but after losing 30 lbs., decided (with last doctor's blessing) to stop it.


I fully intended to stay off of it, but the new doctor suggested I get a carotid artery scan to look for plaque, and it came back normal on the right bulb, but said this for the left:

There is mild-to-moderate plaque in the left carotid bulb. This is associated with 30-49 percent stenosis. This is not hemodynamically significant.
​

Because of this alone, I agreed to go back on Crestor, which I hate due to muscle tiredness side effects.


Here is my only question. As far as I can tell from searching, the phrase "not hemodynamically significant" means "does not affect blood flow".


But if we were talking about a pipe of some sort that performed a critical function, and it was almost 1/3 to 1/2 blocked, would you think that was not "significant"?


Has anyone else had this type of ultrasound? Can you explain what this means?

 

[ShokWaveRider]

I had one last week, and am awaiting the results, will be seeing doc this week.

 

[PatrickA5]

I have one every year. Due for another in a couple of weeks. I have moderate-severe (50% - 70%) plaque in my right PICA. I also have mild stenosis in one of my heart arteries. I've been on a high dosage statin for a few years now and while these blockages aren't shrinking, they haven't gotten any worse either. I don't have any side effects from the statins, so I continue taking them. My doctors tell me that the blockages aren't bad enough to have symptoms, but I've had light-headedness off and on for years now, so who knows?.

Well, now you know where you stand. I wouldn't worry about it too much since it's not bad.

 

[BoodaGazelle]

Thanks for sharing. My real problem, which everyone could probably see, is that I don't want to be on statins at all.


FWIW, I will be following up with my doctor to see if I can get another scan to see if this last was correct. I found at least one place online that stated that these types of ultrasounds are notorious for being misread, being dependent upon the skill of the technician and the reader.

 

[imoldernu]

Definitely not to scare you, but an incident that happened in 1991 to my jeanie. She was line dancing with a group of friends in another park, when we lived in Florida in 1991. In her talking with others, they told her he was talking gibberish. Shortly, they realized she was having a stroke.

Ambulance, quickly to the best hospital in the area. Fortunately.. very fortunately, the premiere surgeon in all of Florida had just finished giving a presentation to a group of doctors st the same hospital. At three o'clock, into the operating room with jeanie. I was notified by phone and went to the hospital to wait. From four until 8 o'clock, no word, until the doctor came out, to talk to me and let me know the operation was a success. He held in his hand a gauze pad, to show me the four inch string of plaque (looked like a long black scab) that he had taken from her carotid artery, by opening it up with a single cut, the length of the artery. A microscopic surgery with the ultimate risk. If at any time, a part of that plaque had broken off, it would have gone to her brain, with the obvious results.

He went on to say he was taking the plaque to be photographed, and to be used in his next lecture. I do believe he was as emotionally drained as I was.

That happened 18 years ago, and she is till with me. A vague scar of some 6 inches from the jawline down the neck is all that remains. A lasting memory that is still vivid to this day.

A terrifying story, not meant to scare, but to keep caution at the forefront of healthcare. I am sure that more recent discoveries have produced different levels of care. In any case, being aware, and taking the suggested precautions IMHO is the correct thing to do.

 

[PatrickA5]

I don't want to be on statins either, but I can't argue with the results.

It probably wouldn't hurt to have a second one done. I've had 3 carotid dopplers done and all have been consistent.

 

[BoodaGazelle]

I don't want to be on statins either, but I can't argue with the results.

It probably wouldn't hurt to have a second one done. I've had 3 carotid dopplers done and all have been consistent.

PatrickA5, has being on statins shown any *reduction* in the amount of plaque?

 

[PatrickA5]

PatrickA5, has being on statins shown any *reduction* in the amount of plaque?

No. And I'm not expecting it to. Just trying to keep it from getting worse.
My next doppler will be the first I've had since losing 60lbs. I'm not expecting any change in the plaque, but my cholesterol numbers are the best they've ever been due to the combination of statins and better eating habits.

Now, if we can just figure out why my heart rate is so low....but that's a different problem.

 

[mountainsoft]

But if we were talking about a pipe of some sort that performed a critical function, and it was almost 1/3 to 1/2 blocked, would you think that was not "significant"?

Has anyone else had this type of ultrasound? Can you explain what this means?

My mom had a stroke in 2017 due to a blocked carotid artery. They did that ultrasound and hers was blocked over 90%. She had surgery to remove the plaque from that artery and has been doing well since then.

Apparently there are four arteries running to the brain, two in front and two in back. My mom's are all clogged around 60-70% but the doctor said they don't do surgery until the blockage is over 70%. I guess as long as blood can get to your brain you're OK.

 

[swakyaby]

With a carotid artery stenosis < 70%, I would expect your PCP would schedule you for regular follow up ultrasounds to monitor its progression. When it gets to “hemodynamically significant” or symptomatic, he’ll refer you to a vascular surgeon.

 

[Ian S]

I had one of those Healthfair test series a couple of years ago and fortunately, I had no plaque. Here's what the table looked like:

 

[braumeister]

I had the carotid artery ultrasound just a few months ago. "Mild" plaque (under 15%) and they said I should have another in five years -- no need to monitor sooner.

FWIW I have had very high cholesterol numbers all my life and I don't use a statin.

YMMV

 

[ShokWaveRider]

Results:

 

[PatrickA5]

Sounds great! Good news!

 

[audreyh1]

Terrific! Wow!

 

[ShokWaveRider]

Thanks all, I thought it would be useful to post the actual results so folk could see the format and terminology.

I am surprised too, as Mum died of a stroke at 64 and had Angina and HBP for years. Father dies of Heart issues at 74. I tend to take after Mum, so you can understand my surprise. I have had them before but never really reviewed them in detail. Thigs change as one ages.

 

[Nemo2]

I've had a couple of them. The first, after my "maybe-it-was-maybe-it-wasn't" TIA in Spain last October......Spanish doctor conducting the test told me that "Any irregularities are insignificant".

Had another this year....again "Nada"

¿Quién sabe?

 

[grasshopper]

I know Calcium Score is mentioned here a lot and I have one scheduled for the trip home in PHX on the way back from Africa in September. So I looked at the comparison of CS to CAU and this is what I found.

Conclusion
We propose that CACS assessment is useful in the diagnosis of, and as a surrogate marker of ASCVD in asymptomatic high-risk patients. Our results also suggest that carotid artery evaluation may have a valuable predictive method in primary and secondary ASCVD prevention and risk assessment. Therefore, although there are no synergic effects of combining carotid artery evaluation and CACS, carotid ultrasound seems to be a better predictive method for assessing ASCVD events in high-risk populations than CACS.

My guess is because I am symptomatic with good heart health this is why my doc ordered CS.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694372/

 

[Dash man]

I’ve had several of them since I first had a cardiac calcium scan a few years ago. I was put on a strong statin and my carotid scans haven’t gotten any worse. Next year I get another nuclear stress test.

 

[Tom57]

Ask your Doctor about 30-49% stenosis and they should say no intervention is needed below 60-70% occlusion. Your age and family history are factors.
I had a 95% occlusion in 2009 (age 62) of the right carotid and had an endarterectomy and 10 years later after annual ultrasounds my right carotid is still less than 15% occluded and my left carotid continues about 40% occluded. I have been on statins since 2009.
My whole reason for the original carotid ultrasound was 3 coronary arteries that were over 90% occluded. Don't be surprised if an angiogram or echocardiogram is in your future. In 2009 I was told to develop a relationship with a Cardiologist and a thoracic surgeon which I did. It is hell getting old.

 

[braumeister]

This may give some reassurance to those reading this thread.

First, I'm a high total cholesterol person. It has been up around 300 all my life.
That's OK with me because I have nice low triglycerides and high HDL so my ratios are excellent.

Second, I had a fairly high calcium score about ten years ago, with the total up close to 400. I took some comfort in the doc's comment that there was no way to tell how long it had been there, and might be leftover from early in my life with no current calcification. Wishful thinking perhaps, so I'm planning to get another one to find out.

Since I'm opposed to statins for various reasons, my new doc made a deal with me. He would get off my case if I agreed to three tests, and I had them this year. First, a AAA (abdominal aorta aneurysm) ultrasound, second a carotid ultrasound, and third a stress echocardiogram.

Passed all three with flying colors, so the doc agreed I'm OK living the way I do. Of course, I'm not in a high risk group otherwise. No history of heart attacks in my family, I'm not a smoker or overweight, and I get plenty of exercise.

On the subject of calcium scores, I think it's worthwhile to recognize that it's only one test. There was a study in the New England Journal of Medicine that looked at nearly 7,000 people over four years and divided them into groups. For simplification, I'll choose two, those with scores from 1 to 100 and those with scores over 300. The higher scoring group had around three times the relative risk of the low scoring group, but look at the absolute risks:

 

[audreyh1]

I know Calcium Score is mentioned here a lot and I have one scheduled for the trip home in PHX on the way back from Africa in September. So I looked at the comparison of CS to CAU and this is what I found.

Conclusion
We propose that CACS assessment is useful in the diagnosis of, and as a surrogate marker of ASCVD in asymptomatic high-risk patients. Our results also suggest that carotid artery evaluation may have a valuable predictive method in primary and secondary ASCVD prevention and risk assessment. Therefore, although there are no synergic effects of combining carotid artery evaluation and CACS, carotid ultrasound seems to be a better predictive method for assessing ASCVD events in high-risk populations than CACS.

My guess is because I am symptomatic with good heart health this is why my doc ordered CS.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694372/

Ultrasound - no radiation exposure.

I think there is a pretty good radiation exposure with CACS, right? Isn’t it essentially a CAT scan?

 

[RAE]

I think there is a pretty good radiation exposure with CACS, right? Isn’t it essentially a CAT scan?

Yes, you do get a fair dose of radiation from the CAC scans, which is one reason why I've decided to not have one done (yet anyway.........I might change my mind at some point). Like Braumeister, my triglyceride/HDL ratio is good, and I did have an echcocardiogram done a while back that turned up no issues, so I don't see a good reason to have a CACS done right now.

This is from the abstract of a recent study on how much radiation you get from a CACS:

"The effective radiation dose was reported as mSv. Mean radiation dosing amongst all 82,214 participants was 1.03 mSv, a median dose of 0.94 mSv. The mean radiation dose ranged from 0.76 to 1.31 mSv across the 33 sites involved with the SHAPE program cohort. Subgroup analysis by age, gender or body mass index (BMI) less than 30 kg/m2 showed no variability. Radiation dose in patients with BMI > 30 kg/m2 were significantly greater than other subgroups (µ = 1.96 mSv, p < 0.001). The use of 64-MDCT scanners and protocols provide the effective radiation dose for CAC scoring, which is approximately 1 mSv. This is consistently lower than previously reported for CAC scanning, regardless of scanner type, age or gender. In contrast, a greater BMI influenced mean radiation doses."

 

[ShokWaveRider]

Not much choice if one has a pacemaker.... "No MRI for you".