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With the established role of occlusive disease of the carotid bifurcation in stroke and the widespread availability of duplex imaging of the carotid bifurcation many patients with occlusive disease of the carotid bifurcation are being detected. Management of these patients is difficult, due to a lack of information on the natural history of occlusive carotid disease detected with duplex imaging.

Risk factor reduction makes sense as it is associated with minimal morbidity, and will potentially have other benefits with respect to reduction in the progression of cardiac, renal and occlusive peripheral vascular disease. Surgery in the form of carotid endarterectomy, however is associated with a small but significant morbidity and mortality so that, it should only be advised if it is thought that the risk to the patient is greater without surgery.

Adrian P. Ireland