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To the Editor.—
In a recent editorial (239:228, 1978) Dalessio recognized that "platelet emboli and fibrinoplatelet mixed clots are the source of most TIAs [transient ischemic attacks], particularly of repeated episodes."These emboli originate from ulcerated atherosclerotic plaques, and it is well known that the presence of ulceration within an atherosclerotic plaque is not related to the size of the plaque. It is not uncommon to observe an intimal ulceration, covered with atheromatous debris and platelet deposits, arising within a plaque that, because of its small size, could not be responsible for any substantial hemodynamic changes in the carotid blood flow.However, the author recommends cerebrovascular arteriography only in those patients with TIAs who exhibit hemodynamic abnormalities in cerebral circulation on Doppler ophthalmic testing and Doppler ultrasonic imaging. These tests are of limited usefulness in demonstrating small ulcerated plaques, and strict adherence to this management protocol would deprive many patients
Pasternak BM. Angiography and Transient Ischemic Attacks. JAMA. 1978;239(20):2114. doi:10.1001/jama.1978.03280470026007
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