In-Office Ultrasounds Can Lead To Reduced Stroke Deaths

In the United States 800,000 Americans will suffer a stroke each year. Of these, 8% of these will die. It is the 4th leading cause of death. Like heart attacks they may come on without warning. Some are heralded by the presence of a “mini stroke” or transient ischemic attack which lasts for just a few minutes and resolves without intervention. It usually takes the form of difficulty articulating words or “dysarthria” or perhaps a subtle facial droop that resolves after a few minutes. It may be forgotten by the patient, since it was not a painful event. A person may have a full blown ischemic stroke with difficulty moving one half of their bodies, or hemiplegia. If the stoke involves the posterior circulation they may exhibit symptoms of cerebellar dysfunction, demonstrating ataxia and speech difficulties and nystagmus. These are life-threatening events and require prompt action on behalf of the individuals.


Strokes occur when accumulation of plaques in the left and right internal carotid arteries form and either continue to accumulate reaching a critical stenosis or narrowing of the artery or when a portion of the plaque breaks off and flows “downstream” occluding blood flow to a territory of the brain. Depending on what part of the brain that region is responsible for, will depend on the presentation of the symptoms that are demonstrated. Ischemic strokes of the middle cerebral arteries will generally demonstrate hemiparesis. Ischemic strokes of the posterior circulation will demonstrate ataxia, dysarthria and nystagmus. The best treatment is prevention. And, multiple studies have demonstrated that surgical treatment is superior to medical treatment. Studies of patients who have had strokes demonstrated that a full 50-70% of patient have lesions that are amenable to surgical treatment with carotid endarterectomy.


For this reason, more and more physicians are assessing the degree of carotid disease via noninvasive carotid ultrasound testing. The data is clear, patients with two or more risk factors for stroke, should be screened with non-invasive carotid ultrasound testing.Risk factors for stroke are hypercholesterolemia, diabetes, heart disease, tobacco and hypertension. Additionally, those patients with symptoms of lower extremity peripheral vascular disease should be screened as well. Depending on the degree of stenosis, and the presence or absence of transient ischemic attack symptoms, then they should be referred to vascular surgery or managed medically, as per the American Academy of Neurology Guidelines of 2015.


Patients who have had symptoms of a transient ischemic attack within 6 months AND have stenosis of 50% or greater should be referred for carotid endarterectomy. In those patients without any symptoms whatsoever, who were screened due to the presence of risk factors or the presence of peripheral vascular disease or a bruit auscultated on examination; a stenosis of greater than 60% should be referred to vascular surgery for carotid endarterectomy. Those with less impressive plaques should be managed medically, with all risk factors optimized.


The carotid ultrasound or duplex measures the degree or narrowing or percentage of blockage through a noninvasive means, and can diagnose carotid plaque leading to a disabling stroke with a high degree of reliability. Convenient portable ultrasound services can accomplish the screening examination of such patients. Vesta Teleradiology partners with various ultrasound companies across the country trained in carotid duplex examination. OurRadiologists demonstrate the necessary expertise required in the interpretation of such tests, where accurate readings make the difference. The technicians and physicians work together to provide the highest level of care.


Vesta with its partners provide various ultrasound scans, including carotid duplex scans, in many Primary Care Practices, in most states across the country. The portable service provides the physician with real time results. These exams are covered under Medicare plans as well as remaining affordable under most platinum and bronze, high deductible private health plans where employees may be responsible for meeting the cost of such tests.


Additionally,Primary Care Practices may contact Vesta for guidance with the billing process. Vesta’s staff can walk your billing department though the process of billing and reimbursement for studies such as ultrasound scans, like the carotid duplex. Vesta partners with state of the art facilities that come to you, as a primary care physician, for ease of exam and immediate results, which can encourage patient compliance. This allows the physician to make the appropriate vascular surgery referral for patients requiring referral for carotid endarterectomy, as per the 2015 Guidelines of the AANon Stroke Prevention. Vesta provides the Primary Care Practice’s a platform to perform their duties including a suite of high quality, cost effective and convenient ultrasound studies, from carotids duplex exams to other exams that may assist you in caring for your patients.


Epidemiologically, there is a significant cost to a stroke. The data indicate that 8% of those with ischemic stroke will die. Of those leaving the hospital, 20%-30% will require long term care. While ultrasound screening of all patients is not cost effective, select screening of those patients discussed, with two or more risk factors for cerebrovascular disease, is recommended. The numbers of strokes are on the rise, due to our aging population. This trend is sure to continue as our baby-boomers hit retirement age.


Physicians must adopt a standardized protocol to screen for those with stroke risk factors,symptomatic or not, and the carotid duplex has been recommended for this purpose. Vesta and its partners have laid out proper protocols to provide these ultrasound scans at you primary care center effectively, conveniently and with high quality. In comparison to the cost of a stroke, the cost of screening is miniscule. In comparison to the cost of malpractice litigation it is miniscule.

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