Carotid stenosis: change of treatment plan based on repeat duplex ultrasonography.
BACKGROUND
This study was conducted to evaluate the change in the treatment plan observed when clinical decisions are made based on initial carotid duplex ultrasonography (DU) performed at an outside center before surgical consultation versus those made based on DU performed in a dedicated vascular laboratory.


METHODS
A prospective study of patients who underwent initial DU at an outside facility and repeat DU in a dedicated vascular laboratory for evaluation of carotid stenosis was performed. Initial DU was compared with repeat DU to evaluate clinical impact.


RESULTS
Ninety-six consecutive patients were evaluated. Disagreement between initial DU and repeat DU was observed in 27.1% of patients. This disagreement led to a change of treatment plan in 23 of 146 (15.8%) carotid arteries studied.


CONCLUSIONS
Reliance on 1 DU in clinical practice, when performed outside a dedicated vascular laboratory, may lead to both unnecessary surgery and missed opportunities for surgery to prevent stroke.