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Arthur C. Walsh, MD
Pittsburgh

JAMA. 1970;214(2):374.

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To the Editor.—

Two interesting letters regarding cerebrovascular disease due to extracranial artery stenosis (213:874, 1970) compared the results of surgical to "nonsurgical" treatment. It seems to me, though, that "nonsurgical" treatment is too broad a category as it may or may not include anticoagulant therapy. The reason for suggesting this apparently unimportant distinction is that my own experience with long-term anticoagulant therapy has been that patients with cerebrovascular disease have ceased almost 100% to have recurrence of their symptoms as long as they are receiving dicumarol. The analysis of long-term bishydroxycoumarin (Dicumarol) therapy in 11 patients (J Amer Geriat Soc 17:93, 1969) showed that all improved during therapy and none deteriorated from cerebrovascular disease while under treatment. Further experience with bishydroxycoumarin therapy in patients with dementia considered to be due to cerebrovascular insufficiency confirmed this almost specific response to treatment when patients are carefully selected (J Amer . . . [Full Text PDF of this Article]

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