To the Editor:& Assuming that a subset of perioperative patients with a high rate of perioperative stroke is identifiable, there is no clear evidence that prophylactic extirpation of a cervical carotid stenosis would reduce the rate. It is a hypothesis that perioperative stroke is mediated by carotid occlusive disease potentiated by intraoperative hypotension. Most perioperative strokes have their onset postoperatively or occur in the absence of carotid occlusive disease.1,2 There are fewer data available concerning the risk of perioperative stroke in elective-surgery patients with high-grade carotid stenosis defined arteriographically or by reliable noninvasive studies. Would Dr. Ropper and his.
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