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J. David Spence, MD, FRCPC

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

Both the recent article and accompanying commentary¹ regarding carotid endarterectomy as the criterion standard for revascularization missed the point. Nearly half the patients in the study were asymptomatic. For most of them, revascularization was unwarranted. Transcranial Doppler embolus detection has been shown to identify patients with carotid stenosis who are at higher risk.^2-3

We reported in 2005⁴ that transcranial Doppler embolus detection was extremely effective at identifying which patients with asymptomatic carotid stenosis may benefit from revascularization. Only 10% of our patients had microemboli, and their 1-year risk of stroke was 15.6%, so they would probably benefit from revascularization. However, the 90% of patients with asymptomatic carotid stenosis without microemboli had only a 1% risk of stroke, with a very tight 95% confidence interval: 1.01% to 1.36%. They cannot benefit unless the procedure can be done with a risk of less than 1%.

Thus, even . . . [Full Text of this Article]

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