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Jerry J. Svoboda, MD; Malur R. Balaji, MD
University of Rochester Rochester, NY

JAMA. 1985;253(15):2192-2193.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

We write to express a difference of opinion with the answer given by Dr David Lefkowitz¹ in the QUESTIONS AND ANSWERS section regarding investigation and management of focal transient ischemic attacks (TIAs). Dr Lefkowitz stated that noninvasive carotid studies "may obviate the need for contrast studies in selected patients" and that "angiography is indicated when the patient has clinical or noninvasive evidence of significant extracranial atherosclerosis without contraindications to surgery."

Although noninvasive carotid studies may eliminate the need for angiography in some patients, the case question concerned a patient with a focal TIA. We feel that patients with focal TIAs require angiography and a cerebral computed tomographic (CT) scan for diagnosis if they are operative candidates. If preangiographic noninvasive studies demonstrate severe carotid stenosis, intravenous digital-subtraction angiography will usually be adequate to confirm this. If noninvasive studies show lesser degress of stenosis or are normal for . . . [Full Text PDF of this Article]

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