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When regress is progress.

In our October issue, we discussed carotid artery blockage. We also wrote about the surgical procedure called endarterectomy, which previously had been the only therapy available to relieve the blockage and thereby reduce the possibility of stroke. We also noted some reports of patients who, on medication and diet therapy alone, seem to show regression (i.e., reduction in the degree of blockage) of carotid plaques.

A German researcher in Heidelburg, Dr. Michael Hennerici, has been studying this problem with the use of a noninvasive technique called color Doppler flow imaging (CDFI). The procedure uses a radar-like principle to produce ultrasound images in color. A plaque (cholesterol deposit) can obstruct normal blood flow through the carotid artery from the heart to the brain, where the artery forks in the neck.

Even a partial obstruction can result in various parts of the brain receiving an uneven oxygen supply. CDFI shows the flow in color--red when the flow is toward one side of the artery, blue when turbulence causes blood to flow to the opposite side. Repeated study of these flow patterns shows changes that may have occurred over time in the plaque size, thereby permitting assessment of the results of medical treatment.

Claims have been made over the years that carotid artery plaques can regress under various kinds of nonsurgical therapy, with resulting decrease in the degree of obstruction. These claims, however, have largely been made on the basis of clinical observation of the patient, rather than careful study of the plaques themselves. The only method of looking at the plaques was angiography--injecting dye into the artery and watching the flow by x-ray. The procedure can be hazardous, however, and can't be used repeatedly in the same patient. Moreover, it shows only the flow pattern and not the structure of the plaque itself.

CDFI, on the other hand, has none of the hazards and provides a much more detailed picture of the flow pattern, as well as three-dimensional images of the plaque. This superior method of study has shown over time that plaques in coronary arteries can regress under medical treatment. As we noted previously, a rigid diet appears to be necessary--10 percent fat and no cholesterol, according to Dr. Dean Ornish of the University of California, San Francisco. He finds that his patients continue to get worse on the 30 percent fat diet recommended by the American Heart Association.
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Title Annotation:treatment of carotid artery blockage
Publication:Medical Update
Date:Dec 1, 1991
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