To the Editor.—
As a vascular surgical specialist, I was dismayed to read of the changing patterns in the practice of carotid endarterectomy in the Cincinnati area, as outlined by Brott et al.1
Of particular concern for all of us practicing good vascular surgery with acceptable stoke and mortality rates was the fact that this article was picked up by the national news service and widely publicized as representative of the results of carotid endarterectomy as a preventative measure for embolic stroke.
The 74% increase in carotid endarterectomies between 1980 and 1984 is probably accurate as a trend throughout the country. This reflects an increasing awareness of the etiologic role of atheromatous emboli from the carotid bifurcation and the ease with which these lesions can now be diagnosed and screened using noninvasive and Doppler imaging studies. In addition, willingness on the part of patients to have the operations and
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