ISET 2018: Carotid Stenosis Live Case Scanning

Carotid scan evidences prior stent and current stenosis findings.

By Brenda Silva

Serving to further enhance information gained by key speakers and presentations, live case scanning at ISET 2018 gave symposium attendees the chance to view live patient carotid, venous, and arterial scans. This virtual hands-on opportunity offered something for every interventional oncologist, regardless of education or experience, with the added benefit of audience participation and a scheduled Q&A session for further information and explanation.

Moderator James F. Benenati, MD, introduced the live scan as a 75-year-old man who had a carotid stent inserted 15 years ago, as well as second stent inserted four months ago. The patient was a high-risk surgical patient because of multiple nodes, but he met the necessary criteria because the stenosis was above 70%. The scans were conducted by Muhammad Hasan as panel members commented and gave their observations on what the scans revealed.

As the patient’s left carotid was scanned, Dennis Bandyk, MD, pointed out, “You can see that he has calcification and minimal deformity but appears to be under good medical management. There is nothing really going on in his common carotid; it’s as if his disease is gone entirely.”

Addressing the issue of the best angle for the scans, John Pellerito, MD, reported, “The rule is 60 or less for the angle, and even though it’s appropriate to use less angle, we all usually default to 60. If you did go less you would have to show it in your notes, so when we have patients who come back we can look at the earlier studies for comparison.”

While looking at the patient’s right carotid scan, Dr. Pellerito observed, “There are definitely some small thyroid nodules, but you could just note it and follow up – put some color on it and see if there are any vascular anomalies present.” Referring back to the stent, he added, “There is clearly some plaque and some narrowing along the vessel, which should be considered.”

R. Eugene Zierler, MD, agreed with Dr. Pellerito, noting, “I don’t think this is a high-risk stenosis, but I agree that there is some cause for concern there.”

Co-moderator Ian Delconde, MD, asserted, “The images where you can see the stenosis best are usually the ones with turbulence, but in the waveform, there’s not too much turbulence seen.”

Dr. Benenati ended the scanning session with comments about stable plaque versus high-risk plaque and how they can create an issue of how much to dilate due to what is external compression and not actual plaque.

When asked for opinions about suggested follow-up time for a patient that presented as the live case did, the panelists’ answers ranged from six months to a year due to issues apparent on the current scans.