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May 17, 1971

Surgical Treatment of Extracranial Arterial Occlusion

Author Affiliations

Port Jefferson Station, NY

JAMA. 1971;216(7):1199. doi:10.1001/jama.1971.03180330073020

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To the Editor.—  The Joint Study of Extracranial Arterial Occlusion (211:1993, 1970) provided valuable data comparing the results of carotid surgical and nonsurgical treatment of extracranial arterial insufficiency in patients without neurological deficits in the three following groups: (1) unilateral carotid stenosis (2) bilateral carotid stenosis and (3) carotid occlusion plus contralateral stenosis.However there is doubt in my mind that the most important data were analyzed in determining the best method of treatment. The authors have decided to compare the value of treatments on the basis of transient attacks in the patients who survive the original hospitalization and surgery. In their analysis surgery is a better therapy in subgroups two and three.Several objections can be offered. First the analysis does not evaluate those who have been injured or have died as a result of the original therapy. Second it evaluates data which are the least important and