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Introduction: Despite considered being a safe and efficacious procedure in patients with moderate to severe symptomatic carotid artery stenosis, carotid endarterectomy (CEA) carries a risk of postoperative cerebrovascular accident (POCVA). There is currently a lack of evidence pertaining to the relationship between cranial vascular integrity and its interaction with intraoperative haemodynamic fluctuations and risk of POCVA. Methods: In this retrospective case-control study, we utilised data collected from patients undergoing CEA for symptomatic carotid artery disease between Dec’05 and Oct’19 in the South Mersey Arterial Centre, UK. Patients with three-dimensional CT angiogram (3D-CTA) and evidence of POCVA were considered as cases, matched with those without such evidence that were considered as controls. 3D-CTAs were analysed following a structured proforma, and haemodynamic changes were obtained from operative notes. Results: Out of 951 patients, a total of 21 cases and 55 matched controls were identified. Presence of atherosclerotic disease in the vertebral arteries (VA) in either side, intracranial atherosclerosis (ICAS) (81% vs 40% and 57% vs 27%; + SD 61 + 23 mmHg vs. 44 + 20 mmHg, p Conclusions: These findings highlight the importance of routinely identifying posterior circulation abnormalities during the preoperative assessment, and judicious blood pressure management during the intraoperative period, both of which have the potential to help to develop a personalised risk stratification pre-CEA and greater intraoperative monitoring during CEA.

To the Editor.— Although the pharmaceutical manufacturer of warfarin sodium (Coumadin) has stated that diabetes mellitus is one of the factors possibly responsible for a decreased hypoprothrombinemic response to the drug, to our knowledge there are no data in the literature to support this claim. Therefore, we studied the effects of warfarin on the prothrombin time (PT) in diabetic and nondiabetic patients. Subjects and Methods.— Patients for the study were found by retrospective and prospective chart review. Excluded from the study were patients with decreased liver function or thyroid disease, those taking any medication reported to interact with warfarin,1and those with a history of alcoholism or other drug abuse. All patients included in the investigation were hospitalized at the beginning of and during at least five to seven days of warfarin therapy. Patient information recorded included age, race, sex, diagnosis, all medications, and pertinent laboratory data such as