017). Including perioperative events at 2 years, there were no differences between groups in ipsilateral stroke, any stroke, disabling stroke, death, or any stroke or death.Comment: The study is interesting in that it suggests that the choice of CEA technique may influence periprocedural events but not long-term ipsilateral stroke or overall death. The limitations of this study are obvious: it used a nonrandomized post hoc analysis, with no information about why one CEA technique was chosen over the other, and lacked a blinded outcome assessment. The authors also note that an infinite hazard ratio confidence interval for ipsilateral stroke Ͼ30 days and the wide odds ratio confidence intervals for death rates indicate that, statistically, a substantial technique-dependent effect has not truly been ruled out by this study. Nevertheless, this was an independently monitored, multicenter study and therefore may have more generally applicable and accurate data than a single-center study.

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Surgical revascularization for lower extremity native artery occlusions is more effective and durable than thrombolysis. Thrombolysis used initially provides a reduction in the surgical procedure for a majority of patients; however, long-term outcome is inferior, particularly for patients who have an FP occlusion, diabetes, or critical ischemia.

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Background and Purpose-Detection of large, hypoattenuated brain-tissue volume on hyperacute CT scan has been suggested as an exclusion criterion for early intravenous tissue plasminogen activator (IV-tPA) treatment. This study assessed the reliability of detection for these findings and their relationship to outcome. Methods-Fifty hyperacute CT scans (Ͻ6 hours after ictus) were selected from a randomized trial evaluating IV-tPA (ATLANTIS trial). Three neuroradiologists blinded to all clinical information evaluated scans for degree of MCA territory involvement (Ͻ33% or Ͼ33%) and the presence of a hyperdense MCA. Evaluations were compared with 24-hour scan results, 30-day infarct volumes, and baseline NIH stroke scale scores (NIHSS). Results-Readers reliably evaluated the degree of MCA territory hypodensity (intraclass correlationϭ0.53, PϽ0.001), with all 3 readers agreeing in 36 of 50 cases (72%). They correctly called Ͼ33% involvement with a sensitivity of 60% to 85% and a specificity of 86% to 97%. The baseline NIHSS was higher when Ͼ33% MCA hypodensity was seen (Pϭ0.021). Detection of significant hypodensity (Ͼ33%) correlated with poorer outcome. When Ͼ33% hypodensity was not detected, mean 30-day infarct volumes were 27.0 to 33.0 cm 3 , versus 84.3 to 123.1 cm 3 when Ͼ33% hypodensity was present (Pϭ0.002). Conclusions-Detection of MCA territory hypodensity on hyperacute CT scans is a sensitive, prognostic, and reliable indicator of the amount of MCA territory undergoing infarction. (Stroke. 1999;30:389-392.)