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June 15, 1970

Extracranial Arterial Occlusion

JAMA. 1970;212(11):1960. doi:10.1001/jama.1970.03170240162026

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To the Editor.—  In a recent joint study of Extracranial Arterial Occlusion reported by Fields et al (211:1993, 1970), the authors elaborated various extracranial vascular patterns. They indicated a controversy between those schooled in the neurologic sciences as opposed to those schooled in the performance of a purely technical procedure. One area of major conflict has been the lack of adequate opacification of the intracranial vessels and their varying anastomatic patterns in studies performed by vascular surgeons. The importance of this was reported in 1960 by Doctor Gurdjian of Wayne State University. The authors report significant postoperative complications in those patients with carotid stenosis when the stenosis is below 50%. They even comment, "The reason for this difference is not yet clear."It is more than likely that the cerebral circulation has not adjusted itself to this borderline extracranial occlusion and it is this lack of adequate collateral circulation