There never is a perfect time. If carotid angioplasty is evaluated prematurely, a promising technique may be felled before it is proven. On the other hand, if no randomized controlled clinical trials take place, we may end up in the same quandary as exists regarding angioplasty for peripheral vascular disease, where we are still uncertain about its usefulness 3 decades after it began.1
By homonymic coincidence, this controversy is among a fanfare of Fergusons. Robert and John heralding the potential advantages of angioplasty and Gary sounding a note of caution. They all advocate the scientific evaluation of angioplasty. The difference is in timing. Robert and John are for a clinical trial, but not yet. Gary thinks that clinical trials should be undertaken now and only in situations where carotid endarterectomy is not known to be beneficial. Yet, their views are compatible. It would take some time to mount a
Hachinski V. Carotid Angioplasty. Arch Neurol. 1996;53(7):700–701. doi:10.1001/archneur.1996.00550070142025
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