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When Felix Eastcott and his team resected the carotid artery of a woman with transient ischemic attacks in 1954, they little realized that this was the beginning of the surgical prevention of stroke, and that in the next two decades, carotid endarterectomy was to become the most frequently performed vascular procedure in the world. Although carotid-artery stenosis accounts for no more than 15 percent of ischemic strokes, carotid endarterectomy remains the most powerful form of stroke prevention. Few strategies, medical or surgical, are associated with an absolute risk reduction of 16 percent. Unfortunately, success proved to be a mixed blessing.
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