The ESC (European Society of Cardiology) Guidelines for Peripheral Arterial Diseases states that in asyntomatic patients (no TIA or Stroke in the previous 6 months) with morphologically carotid stenosis between 60-99% (NASCET method) and average surgical risk, CEA should be considered in patients with clinical or imaging characteristics that may be associated with an increased risk for ipsilateral stroke. Those risk factor are: controlateral stroke or TIA; ipsilateral silent infarction on CT; plaque with lipid-rich necrotic core or intraplaque hemorrhage at MRA; >20%stenosis progression, echolucent plaque, large plaque, spontaneous embolization at the transcranial Doppler, increased juxta-luminal hypoechogenic area, impaired cerebral vascular reserve on US imaging. From this point of view seems that ther's no role for hemodynamic evaluation of plaque (pre and post stenotic PSV) by Doppler US for risk estimation.
My question if there are any evidence to support hemodynamic evaluation of carotid plaques by Doppler US for risk estimation and management decision in asyntomatic patients.
Thank you so much,
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