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Letters |

Plaque Morphology as a Risk Factor for Stroke—Reply

Phil B. Fontanarosa, MD, Deputy Editor; Henry J. M. Barnett, MD; Michael Eliasziw, MD; Heather Meldrum, BA
JAMA. 2000;284(2):177. doi:10.1001/jama.284.2.175.
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In Reply: Dr Bluth correctly notes that the degree of stenosis is not the only variable that increases the risk of stroke. He cites studies showing that modern ultrasound done in well-equipped and closely supervised laboratories can distinguish between echodense and echolucent carotid lesions. Echolucency (corresponding to soft and friable plaques) along with the degree of stenosis led to an increased risk of stroke. However, such sophisticated ultrasound technology did not exist when NASCET was launched in 1987. At that time it was an inadequate method to evaluate either the severity of stenosis or the nature of the carotid lesion causing the symptoms. A major study contemporaneous with NASCET could not conduct risk and benefit analyses based on the degree of stenosis as evaluated by ultrasound.1 Thus, the NASCET protocol appropriately required conventional angiography.


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