Racial inequity of access to carotid imaging.

Abstract

To the Editor: While we welcome research into stroke in patients of African and Caribbean origin, we have a number of concerns regarding the conclusions of Oddone et al on racial differences in the use of carotid imaging.1 Lacunar stroke may give a presentation identical to that of a transient ischemic attack (TIA). There is a high prevalence of lacunar stroke in people of Afro-Caribbean heritage both in the United States and the United Kingdom. Furthermore, there is a negative correlation between lacunar stroke and carotid disease.2 Thus, when the strictest indication for carotid imaging is used (to define a symptomatic stenosis in a patient suitable for surgery), a higher proportion of African-American patients may not have qualified. (The brain imaging was not reviewed in the study.) Of the African-Americans in the TIA group, 34.9% (30 of 86) had had a previous TIA and 33.7% (29 of 86) a previous stroke, compared with 15.2% (28 of 184) and 16.3% (30 of 184) of white patients. As the study only …