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December 1986

Shunting During Carotid Endarterectomy-Reply

Arch Neurol. 1986;43(12):1223. doi:10.1001/archneur.1986.00520120009006

In Reply.—  As the section editor of the "Controversies in Neurology" section of the Archives, I appreciate Dr Davenport's provocative style. On the other hand, it is difficult to have a controversy when one's partner in the debate does not appear to know where one stands, or when one does not know where he stands. In my comment,1 I stated that "most intraoperative strokes are embolic and not hemodynamic," ie, they cannot be predicted by intraoperative monitoring. I also said that "Dr Ferguson is now prepared to consider the hypothesis that a small subgroup of patients with severe electroencephalographic change and mean stump pressures of 25 mm Hg or less may benefit from routine shunting" (my italics). In Dr Ferguson's own words: "But, it must be emphasized that this hypothesis has yet to be proven."2 Moreover, in the concluding sentence of my comment I subscribed to Dr Ferguson's view that

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