A Difficult Case: Perform left carotid endarterectomy without delay

doi:10.1136/bmj.310.6992.1449b

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John M Porter, professor of surgerya

^a Division of Vascular Surgery, Oregon Health Sciences University, Portland, Oregon 97201-3098, USA

This patient presents a conundrum. The clinician is faced not only with the issue of propriety of carotid surgery in the face of a probable stroke in evolution but also with the prospect of carotid surgery in a patient who probably has severe associated coronary artery disease.

When encountering a patient with fluctuating neurological symptoms and high grade carotid stenosis my first …