The success and general acceptance of coronary artery bypass grafts has provoked renewed parallel interests for an aggressive approach toward asymptomatic carotid artery stenosis and ulceration to prevent strokes. While extirpation of a menacing and potentially offending lesion may appear rational, the issue of thromboembolic strokes cannot simply be reduced to the presence or absence of an atheroma at the carotid artery bifurcation. Final judgment on the guilt or innocence of an asymptomatic atheroma, a common finding, will ultimately, however, require insight into its complex interactions with biorheologic factors, platelet/ leukocyte/endothelium metabolism, and collateral circulation which conspire to trigger thromboembolic strokes. Based on the precedence of published experiences, the verdict rendered should be "innocent until proved guilty," a conclusion reached from lack of evidence demonstrating benefit conveyed by so-called prophylactic endarterectomy.
To resolve the controversies over prophylactic endarterectomy, as well as the pathophysiologic mechanisms leading to thromboembolic strokes, prospective clinical
Yatsu FM, Fields WS. Asymptomatic Carotid Bruit: Stenosis or Ulceration, a Conservative Approach. Arch Neurol. 1985;42(4):383–385. doi:10.1001/archneur.1985.04060040097020
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