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July 1997

Asymptomatic Carotid Artery Stenosis-Reply

Author Affiliations

Bowman Gray School of Medicine Medical Center Blvd Winston-Salem, NC 27157-1078

Arch Neurol. 1997;54(7):800. doi:10.1001/archneur.1997.00550190005003

In reply  I thank my esteemed colleagues in neurology for their temperate and informative reply to my challenging editorial.I remain skeptical that the Delphic technique should be used for making policy. When Copernicus, and later Galileo, asserted that the earth revolved about the sun, consensus groups judged them to be wrong. Semmelweiss, O. W. Holmes, Sr, and Lister all had similar experiences when oracles in Vienna, Austria, Budapest, Hungary, Boston, Mass and England rejected their recommendations.I reiterate my view that ongoing competence audits of all endarterectomists, not just a sampling from Toronto, Ontario, must become routine both in Canada and in the United States. Furthermore, I maintain that patients with severe carotid stenosis should be considered for endarterectomy in some circumstances. Instead of awaiting a 911 crisis requiring emergency triage and 90-minute window for intervention with tissue-type plasminogen activator, endarterectomy, or other risky interventions, I suggest that an