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Vladimir Hachinski, MD, FRCPC, DSc
London, Ontario

Arch Neurol. 1999;56:881.

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

PREVENTION is infinitely more effective than treatment, hence the appeal of striking before disease does. Castaldo argues that in asymptomatic patients selected carefully according to criteria encompassed in his C-A-R-O-T-I-D mnemonics, endarterectomy can be of benefit. Chaturvedi counters by pointing out that the absolute risk reduction in ipsilateral stroke rate was only 1.5% between the treatment and control groups. Sixty-seven patients need to be operated on to prevent 1 stroke. He questions whether spending $1.5 million to prevent 1 nondisabling stroke can be justified.

The discussants raise several important issues:

1. Risk of stroke in carotid stenosis. Historical data have proved misleading as guides to the risk of stroke in carotid stenosis. It is much lower in asymptomatic patients (2.2% per year) and much higher (13% per year) in symptomatic patients than was projected from historical evidence. This suggests that historical data are largely of historical . . . [Full Text of this Article]