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Image of the Week: Mobile Carotid Plaque

from SCAI

From Nov. 6:

Kamal Gupta, MD, FSCAI, and second-year cardiology fellow Andrew Waters, MD, both of University of Kansas Medical Center, review a case of a 69-year-old male with past medical history of hypertension, HLD, ESRD, COPD and active tobacco use. The patient was found to coincidentally have a bilateral carotid bruit, despite not previously having any neurologic symptoms. A carotid duplex showed mild heterogeneous placque on the right side and moderate stenosis of the mid-led ICA. He was advised to quit smoking and and started on statin therapy. Upon the one-year follow-up appointment, the patient remained asympotmatic, was still an active smoker, had questionable compliance with medications and was displaying an interval formation of a 2x 1 millimeter highly mobile placque in the proximal left ICA and blood pressure of 170/90 and LDL of 90. What are the best next steps in the management of this patient? What do you think? more

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