Carotid Bruit and Risk of Stroke in Elective Surgery

To the Editor:& Assuming that a subset of perioperative patients with a high rate of perioperative stroke is identifiable, there is no clear evidence that prophylactic extirpation of a cervical carotid stenosis would reduce the rate. It is a hypothesis that perioperative stroke is mediated by carotid occlusive disease potentiated by intraoperative hypotension. Most perioperative strokes have their onset postoperatively or occur in the absence of carotid occlusive disease.^1,2 There are fewer data available concerning the risk of perioperative stroke in elective-surgery patients with high-grade carotid stenosis defined arteriographically or by reliable noninvasive studies. Would Dr. Ropper and his.