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Extracranial cerebral vessels duplex ultrasound findings and therapeutic consequences Sonographic findings Clinical presentation Therapy Plaques Internal carotid artery stenosis Not stenotic hemodynamically, asymp- tomatic or symptomatic Hemodynamically significant stenosis 70asymptomatic Stenosis 70, asymptomatic 50 70 stenosis, symptomatic 70 stenosis, symptomatic 70 stenosis, stage IV Stages I-IV Steal syndrome, symptomatic High-grade Mostly due to trauma, asymptomatic, patent or thrombosed false textile trading companies in dubai Asymptomatic if nonstenotic Symptomatic if associated with co,panies sis Wall thickening (macaroni sign) with or without hemodynamically signifi- cant stenosis Well perfused tumor in the carotid bifurcation (color duplex) High-grade stenosis, asymptomatic High-grade stenosis, symptomatic Medical management Ib management Surgical reconstruction (TEA) acceptable but only proven if perioperative risk is low (according to ACAS study): if perioperative morbiditymortality rate 3 annual stroke rate of 2 in medical care group versus 1 in surgical group surgery only if life expectancy 5 years Surgical reconstruction (TEA): acceptable but not proven in TIA 6 months and plaque morphology suggesting a high risk of embolism (ulceration, hypoechogenicity, irregular sur- face) Indication for surgery (TEA): proven risk reduction relative to natural history increases as the peri- operative morbidity and mortality rate decreases (target: 5 ; Table 5.

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Pulling Pulling FIGURE 17. Now on the side .