Echocardiography society issues new guidelines for carotid ultrasound

February 11, 2008 Echocardiography society issues new guidelines for carotid ultrasound H. A. Abella -------------------------------------------------------------------------------- The American Society of Echocardiography has issued a new consensus statement for interpreting and responding to results of carotid artery ultrasound. The guidelines set carotid artery wall thickness values greater than the 75th percentile as the threshold for aggressive treatment. Carotid ultrasound has been used as a research tool for more than two decades and is increasingly turning into an established clinical practice. The ASE consensus statement provides standards for patient selection, scanning protocol, and interpretation to guide doctors on proper patient selection and management decisions. It provides specific guidance for detecting early atherosclerotic plaques and increased carotid intima-media thickness (CIMT). The document, however, recommends skipping imaging unless the results would be expected to alter therapy. These guidelines will help physicians feel more confident recommending aggressive preventive therapies if ultrasound reveals the walls of the carotid arteries are thicker than established cutoff points or percentiles for patients of similar age, sex, and race. They also provide recommendations for training and certification of sonographers and sonologists. The document sets the 75th percentile --which includes vessel wall thicknesses ranging from about 0.6 mm to 1.3 mm, as defined by eight large cohort studies-- as the threshold for aggressive treatment. Those who have CIMT equal or greater than that level for patients of similar age, sex, and race are considered to be at increased cardiovascular risk. There is a great interest in identifying patients who don't have symptoms of heart and blood vessel disease but who are at higher risk than they may appear. Having a safe, noninvasive approach for diagnosing early arterial disease and revealing potential heart disease will give doctors and patients the information they need to select the best treatment options, said Dr. James H. Stein, a cardiologist at the University of Wisconsin School of Medicine and Public Health.

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