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August 3, 1970

Angiographic Survey of Carotid Artery Disease

JAMA. 1970;213(5):875. doi:10.1001/jama.1970.03170310153065

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To the Editor.—  Fields et al (211: 1993, 1970) have reported a series of cases in long-term follow-up comparing operative and nonoperative extracranial vascular disease. The authors mention the continued controversy between those physicians schooled in the neurologic sciences and their insistence upon adequate demonstration of the intracranial vascular pattern with its anastomotic variation vs those schooled in the purely extracranial approach, directing the entire attention of the attending physician (vascular surgeon) to the immediate evaluation and care of the carotid lesion. The importance of the demonstration of the intracranial arterial pattern has been repeatedly stressed in the various neurosurgical publications and this was pioneered by E. S. Gurdjian, MD. The present study indicating significant postoperative complications in those patients with carotid stenosis of less than 50% for which the authors comment, "The reason for this difference is not yet clear," I think points up even more the need for