To the Editor.—The authors of the recent article by Weinberger et al1 ought to be congratulated for attempting to dissect the causes of cerebrovascular events in a group of patients with nonvalvular atrial fibrillation, thereby drawing attention to the fact that a cerebrovascular event in a patient with atrial fibrillation is not necessarily caused by embolic complications related to atrial fibrillation, but may actually be due to atherosclerotic lesions at the carotid bifurcation. However, cerebrovascular events may also be caused by intracranial disease, and this possibility has not been adequately addressed by the study.
In attempting to determine whether a stroke is due to a cardiac embolism or disease of the carotid bifurcation, the presence of multiple transient ischemic attacks (TIAs) occurring with a similar pattern in 94% of patients with disease of the carotid bifurcation and 88% of patients with basilar artery disease is noted to occur
LYNFIELD J. Noninvasive Evaluation of the Extracranial Carotid Arteries in Patients With Cerebrovascular Events and Atrial Fibrillation. Arch Intern Med. 1990;150(2):458-460. doi:10.1001/archinte.1990.00390140152032