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By Nicholas Bunce

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Sixteen Veterans Affairs medical centers with a low surgical morbidity and mortality rate recruited 193 patients, of whom 92 had surgery. All received aspirin 325 mg/day. 6% in the medical group. An atlas of contrast-enhanced angiography 44 CONCLUSION Carotid artery disease is a common condition that can lead to significant morbidity and mortality. Identification and management of risk factors can reduce the stroke event rate. Non-invasive assessment by combined Doppler ultrasound and MRA followed by X-ray angiography for selected cases appears to be the safest and most effective method for identifying those patients that require surgery.

Nienaber CA, von Kodolitsch Y, Nicolas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993; 328:1–9 17. Masani ND, Banning AP, Jones RA, Ruttley MST, Fraser AG. Follow up of chronic thoracic aortic dissection: comparison of transesophageal echocardiography and magnetic resonance imaging. Am Heart J 1996; 131:1156–63 18. Campbell M. Natural history of coarctation of the aorta. Br Heart J 1970; 32:633–40 19. Steiner RM, Gross G, Flicker S, et al.

Six hundred and fifty-nine patients were assessed and 328 were referred for surgery. 8%. At 2 years, the risk of ipsilateral stroke was 9% in the surgical group and 26% in the medical group. The Carotid Endarterectomy and Prevention of Cerebral Ischemia in Symptomatic Carotid Stenosis study29 investigated patients with a greater than 50% stenosis of the internal carotid artery and a previous cerebral event. Sixteen Veterans Affairs medical centers with a low surgical morbidity and mortality rate recruited 193 patients, of whom 92 had surgery.

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