Both the recent article and accompanying commentary1 regarding carotid endarterectomy as the criterion standard for revascularization missed the point. Nearly half the patients in the study were asymptomatic. For most of them, revascularization was unwarranted. Transcranial Doppler embolus detection has been shown to identify patients with carotid stenosis who are at higher risk.2,3
Spence JD. Asymptomatic Carotid Stenosis: Criterion Standard Should Be Medical Therapy. Arch Surg. 2009;144(4):382–383. doi:10.1001/archsurg.2009.16
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