ABSTRACT
Stroke Unit, Department of Neurology, Royal Perth Hospital and School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
Because up to 85% of all first-ever ischemic strokes are unheralded by ‘‘warning’’ transient ischemic attacks (TIAs), and about one-quarter of these are caused by carotid stenosis, it is likely that about one-fifth of all ischemic strokes can be attributed to carotid stenosis that was hitherto asymptomatic neurologically (1). If these asymptomatic carotid stenoses could be detected safely and cost-effectively before they become symptomatic, and removed safely and effectively by carotid endarterectomy or stenting, it is possible that many strokes could be prevented. But can we safely and cost-effectively identify neurologically asymptomatic carotid stenosis, quantify the risk of stroke that it affords, and balance the risks and benefits of screening for carotid stenosis and undertaking carotid endarterectomy to treat the carotid stenosis and reduce the risk of stroke?
