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who have neurologic impairment during carotid artery clamping are exposed to the risks of shunt placement, including microembolization and local vessel trauma.” But at the same time, management of blood pressure should not lead to an increase in the probability of cerebral ischemia and thereby an increase in the incidence of shunt usage. We acknowledge that the increase in the rate of shunting was not statistically significant; however, with 80 patients in each group, the authors would have had adequate power to show a statistically significant increase in the requirement of shunt insertion with P < 0.05. We caution the authors and others eager to use dexmedetomidine for sedation during CEA that reduction of systolic and diastolic blood pressure may cause more harm than good in this patient population.