To the Editor: In his Clinical Crossroads article about Ms E, a 60-year-old woman with mild memory impairment, Dr Ellison indicated that “it is reasonable . . . to obtain carotid ultrasound studies to determine whether blood flow is compromised to the point of requiring intervention for stroke prevention.”1 Although Ms E has stroke risk factors, white matter disease, and an upgoing toe, she was not reported to have had a clinical event consistent with stroke or transient ischemic attack (TIA). Therefore, even if she had significant carotid stenosis, the stenosis would not be considered symptomatic, and revascularization therapy would not be indicated.
The best available evidence suggests that because of a higher operative risk in women and a lower risk of stroke without surgery, carotid endarterectomy offers no clear benefit to women with asymptomatic carotid disease, regardless of degree of stenosis. Combining the data from 2 large randomized controlled trials of carotid endarterectomy for asymptomatic stenosis,2 - 3 surgery appears to be associated with a significantly reduced risk of any stroke or perioperative death among men (odds ratio, 0.49; 95% confidence interval, 0.36-0.66) but not among women (odds ratio, 0.96; 95% confidence interval, 0.63-1.45).4
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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