Hi everyone, thank you for having me. It's an honor. So um I went to go visit my 95 year old mother and she looked at my hair and she goes, Jeffrey, you're not 18 anymore. Come on man, I feel like it. Anyway, thanks for having me again. So I hear a carrot brewery and now what? There's more to a Corrida brewery than just a brewery. So um I have no disclosures. So actually what is a carrot? A brewery? So it's a vascular sound heard with a stethoscope over the extra cranial carotid artery. So it's turbulent flow. There's linear flow on the media, right at the bifurcation area and turbulent flow on the outside. It's a noise in the artery that's created by turbulent. Well in the northern Manhattan study um they started Well over like 30 200 people that was in the study. 686 patients fit the criteria for this study. And they found 28 patients had a character brewery, which was only 4.1 and 15 patients out of that, 28 Had greater than 60% stenosis. Um Um 44% false negative rate. And so a patient without a karate verily can still have a finding of significant disease. It's in a small percent, but they can still have disease. So overall from this study. Um they found that it's a poor indicator of Hema dynamically significant disease, but it doesn't mean that there isn't plaque there. So in 89% of the of the cases, there was actually plaque identified, but in their study they were just looking at over 60%. So Davies and humphreys, they looked at Karratha breweries. They had 30 331 patients And 33% were referred because of a craft brewery. And so what they found was 30%, were found to have moderate to severe carotid stenosis. Um, their criteria was the moderate, which was greater than 30 And greater than 70% for their severe. So that's why this was 37 And of note 17% without a crowded brewery had moderate to severe disease. So, um, it's, that's a note of uh, to take note of that. So these are the risk factors for actual carotid disease. But to me it's a really important slide because getting in a routine of putting your stethoscope to their neck is extremely important. So when I'm assessing peripheral vascular disease in the lower extremities, I'm focusing on pulses. I'm focusing on ephemeral, papa teal and the petals and really focusing and not thinking about their risk factors. But when I put my stethoscope to their neck, it really makes me think about all of their risk factors are smoking their diabetes, hypertension and so forth. So this is important to me because when, especially when I hear that Kurata brewery man, it's just my, my mind starts going, you know what type of risk factors do these patients present with. It's an important list there. So the benefits of it. It's and some of my patients there, it's just like they're leaning forward waiting for me to put my stethoscope on their neck. You know, sometimes I got to tell him, I'm like, listen, this is a poor man's way of diagnosing carotid disease. So, but the patients really feel that you've done, you know, they're getting their money's worth, they're coming to our office, they're putting it on co page. You got to put your hands on these patients, you know, and putting a stethoscope up to their neck is extremely important to them. It's really important to them hearing a karate brewery or not is another thing. So, you know, what do you do if you hear a karate brewery? So, um, you know, again, it just automatically leads me to start thinking about maximum maximum medical therapy. What are they doing? Are they exercising are they smoking? And then, you know, at the end of the day, I'm exhausted from being a cheerleader of, you know, quit smoking exercise and and all that. So it's it's it's important to me because it's it's one of those programmed um steps that I take in in my vascular evaluation of vascular patients is making me think about all those risk factors. So it may not be an indicator of I should put hemo dynamically significant disease, but it is an indicator of disease in 89% of the patients that had a character. Very, so it's important. So, you know, these days we're relying on our technology and less on our on our experience or you know, ability to do physical exams and so forth. It's easy to not do the um stethoscope on their neck. I just think it's beneficial to do it um for a number of reasons. But um. Mhm. So If, let's say uh you know, 50 something year old patient comes in and you don't hear a karate brewery, you know, when when do you do a carotid duplex scan? You know? Well, right away I go to that list of risk factors, family history, smoking diabetes at some point in time, you're gonna want a baseline. If somebody comes in, they're smoking age of 62, they have diabetes, they got a carrot, a brewery, that's a no brainer. We're gonna need to get a baseline and see what's going on with their carrots Even though in a in a small percentage it's gonna tell us that it's greater than 60%,, but still we know that atherosclerotic disease and crowded progressives, especially with higher risk factors. So um that's it. I um I use I use my ask irritation of the neck to influence me to make sure I do a complete job of the vascular exam. Thank you. I appreciate your time
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