BMJ 1994;308:657 (5 March)

Letters

Avoidable factors in stroke

EDITOR, - Mr Adiseshiah has pointed out the role of carotid endarterectomy in symptomatic patients with >70% stenosis of the ipsilateral internal carotid artery.1 The annual incidence of transient ischaemic attacks has been estimated to be 0.4/1000. Of the patients affected, between 5000 and 10000 would be suitable for carotid endarterectomy each year, which would reduce the number of strokes by between 500 and 1000.2 The role of carotid endarterectomy in symptomatic patients with moderate stenosis of the carotid artery and in asymptomatic patients with severe stenosis is currently being evaluated by international trials.

Thus the benefit of carotid endarterectomy has been proved in a relatively small subset of patients. Recent research has identified other effective measures to prevent strokes, which may have a greater impact. The Antiplatelet Trialists' Collaboration showed that low dose aspirin reduces the risk of major stroke and reduces mortality in symptomatic patients.3 Several large trials . . . [Full text of this article]


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