In July 1995, at the Neurology Grand Rounds, Dr Louis Caplan discussed Mr C, a man who had been found to have asymptomatic carotid bruits the preceding March. Carotid ultrasound examination revealed occlusion of the right internal carotid artery and suggested 50% occlusion of the left. Now 80 years old and still active as a classical musician who performs and teaches, the patient had a history of arteriosclerotic cardiovascular disease, with coronary artery bypass graft surgery performed successfully in 1989. Other than occasional, transient blurred vision, which Dr Caplan thought unrelated to the carotid disease, the patient felt well and had no symptoms referable to the cardiac or central nervous system. Discussion centered on the risks and benefits of watchful waiting vs carotid endarterectomy.
Mr C, the patient: Since last year, there has been no significant increase in discomfort caused by the condition of my carotid arteries. I have become