In a recent article Streifler et al1 reported the results from the North American Symptomatic Carotid Endarterectomy Trial (NASCET); they conclude that "the better prognosis of retinal transient ischemic attack [RTIA] in comparison with that of hemispheric transient ischemic attack [HTIA] observed in our study does not preclude the benefit of carotid endarterectomy for those patients."
We disagree with this conclusion for a number of reasons. The RTIA group had an ipsilateral stroke rate of 16.6%, but this consisted of minor strokes only, ie, symptoms resolved within 90 days. The 2-year risk of permanent stroke was zero. Yet the authors would recommend subjecting these patients to carotid endarterectomy with a 2.1% perioperative risk of death and major stroke.2
In addition, the results from the surgical arm of NASCET are not presented or compared. The difference between a 16.6% stroke rate for the RTIA group and a 9% stroke
Cornblath WT, Trobe JD. Retinal Transient Ischemic Attack. Arch Neurol. 1996;53(4):294. doi:10.1001/archneur.1996.00550040020003
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