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May 19, 1978

Angiography and Transient Ischemic Attacks-Reply

Author Affiliations

Scripps Clinic Medical Group, Inc LaJolla, Calif

JAMA. 1978;239(20):2114-2115. doi:10.1001/jama.1978.03280470026008

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In Reply.—  My editorial was wide-ranging and was concerned primarily with the role of platelets and their antagonists in transient cerebral ischemia, as the title of the editorial clearly indicates. I mentioned use of noninvasive techniques for assessing extracranial blood flow only in passing, attempting to fit them into a schema for medical management. In our institution we prefer to screen all our patients with suspected TIAs with noninvasive techniques, and invariably, using our study battery, a lesion can be demonstrated if one is to be found. Obviously, if no lesion is found, if the clinical suspicion is strong that TIAs are, in fact, related to extracranial cerebrovascular disease, and if the patient is a fit candidate for surgery, we would proceed with angiography.I do not imply that one should use either noninvasive techniques or angiography, and I believe that the editorial makes that point clear. In my view,