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August 1995

The Identification by Imaging Methods of Patients Who Might Benefit From Carotid Endarterectomy

Author Affiliations

From the Departments of Clinical Neurological Sciences (Drs Barnett and Eliasziw) and Epidemiology and Biostatistics (Dr Eliasziw), University of Western Ontario; and The John P. Robarts Research Institute, London, Ontario (Drs Barnett and Eliasziw and Ms Meldrum).

Arch Neurol. 1995;52(8):827-831. doi:10.1001/archneur.1995.00540320111019

Overwhelming proof exists that ischemie stroke can be prevented, or at least delayed, for a large number of individuals. Many strokes that resulted from severe symptomatic carotid artery stenosis need happen no longer. Effective treatments have been established by the time-consuming and expensive process of randomized clinical trials. Alas, all other methods seeking the truth about therapeutic benefit are less perfect and frequently misleading. Paradoxically, endarterectomy is complicated by stroke, the very disaster that it effectively reduces. This paradox demands of the practitioner that the indications for this therapy and the care with which it is administered must be precisely defined and scrupulously monitored. This communication will discuss who should and who should not undergo carotid endarterectomy (CE) by focusing on the arterial imaging methods that will provide the essential preoperative information to help ensure appropriate selection of candidates.1

PATIENTS PROVEN TO BENEFIT FROM CE  The proven indications for

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