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On the basis of 20 followup studies in patients with transient ischemic attacks or minor ischemic stroke associated with an occluded carotid artery,the annual risk of stroke was 5.5%(95%confident interval[CI],5.0%to 6.0%),and that of ipsilateral stroke(distinguished in 11 of the 20 studies)was 2.1%(95%CI,1.6%to 2.8%).Patients with a compromised cerebral blood flow as measured by positron emission tomography,single-photon emission CT,transcranial Doppler,or stable xenon CT(six studies)have an even higher annual risk of stroke(all strokes:12.5%;95%CI,8.9%to 17.5%; ipsilateral stroke:9.5%;95%CI,6.4%to 14.0%).Because a compromised cerebral blood flow may be an important causal factor in patients with symptomatic carotid artery occlusion,medical and surgical options for treatment are reviewed in this light. |
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