To the Editor.
—The commentaries by Drs Yatsu and Fields and by Drs Quiñones-Baldrich and Moore on the management of asymptomatic patients with carotid bruits and carotid stenosis provide two extreme perspectives.Drs Yatsu and Fields believe discovery of an asymptomatic neck bruit does not justify investigation since the risk of thromboembolic stroke is low. Drs Quiñones-Baldrich and Moore maintain that prophylactic endarterectomy is indicated for lesions of greater than or equal to 70% stenosis, assuming the patient is healthy, and that surgical morbidity and mortality is less than 3%.Our calculations indicate that surgery should be contemplated only for patients with a stroke risk of at least 5% per year.1 Assuming a mortality from causes other than stroke of 4% per year, a perioperative stroke or death rate of 3%, and a stroke risk reduction of two thirds (after uncomplicated surgery), the "break-even point" (after which a beneficial
Chambers BR, Norris JW. Carotid Bruit Controversy. Arch Neurol. 1985;42(5):423. doi:10.1001/archneur.1985.04060050017002