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Image of the Month—Quiz Case FREE

Ruth L. Bush, MD; Charles C. Bianco, MD
[+] Author Affiliations

From the Cardiac and Vascular Surgery Center, Tallahassee Memorial Hospital, Tallahassee, Fla.

Section Editor: Grace S. Rozycki, MD

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Arch Surg. 2003;138(1):109. doi:10.1001/archsurg.138.1.109.
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A HEALTHY 72-YEAR-OLD woman was referred to a vascular surgeon after a carotid duplex scan demonstrated elevated velocities in her left internal carotid artery, consistent with an 80% to 99% stenosis. Questioning revealed an absence of symptoms such as extremity numbness or tingling, dysarthria, or amaurosis fugax. She was nonhypertensive and had never used tobacco products. Furthermore, her lipid and serum creatinine levels were within normal range, and there was no family history of atherosclerotic disease. The primary care physician gave her a regimen of one aspirin per day.

Because of the discrepancy between her duplex findings and the lack of atherosclerotic risk factors, a carotid arteriogram was performed (Figure 1).


A. Schedule carotid endarterectomy

B. Continue antiplatelet therapy and observation

C. Perform percutaneous dilatation of all affected arteries

D. Perform surgical graduated dilatation of stenotic carotid artery Article


Corresponding author: Ruth L. Bush, MD, Cardiac and Vascular Surgery Center, 1405 Centerville Rd, Suite 5000, Tallahassee, FL 32308 (e-mail: rlbush@aol.com).




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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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