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David Lefkowitz, MD
Bowman Gray School of Medicine Winston-Salem, NC

JAMA. 1985;253(15):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.

In Reply.—

I appreciate the opportunity to reply to Drs Svoboda and Balaji's comments regarding the management of patients with TIAs. Their letter raises some important issues that could not be addressed in detail in my original response because of limited space in a forum such as QUESTIONS AND ANSWERS.

Drs Svoboda and Balaji's major points are all corollaries of their basic thesis that "anything other than a normal [antiographic] study in the implicated carotid should indicate surgical endarterectomy," regardless of the magnitude of the abnormality. I submit that this approach is extreme and inappropriate for reasons I will discuss below. It does, however, explain their recommendation that all TIA patients with acceptable surgical risk undergo arteriography since they would consider even minor abnormalities, which might not be as well visualized by ultrasound, to be surgical lesions. Since I do not share this view, I am more inclined to forego . . . [Full Text PDF of this Article]

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