Summary:With 500,000 new strokes occurring annually in the United States, 145,000 deaths result. Stroke remains the third leading cause of death in the United States after cardiovascular disease and cancer, but it is also a leading cause of long-term physical and intellectual disability. Billions of dollars are lost in productivity and health-care resources. The total annual economic cost of stroke in this nation was estimated to be $18 billion in 1993 (1). Of every 100 patients surviving a stroke, 10 will be unimpaired, 40 will have mild residual disability interfering with activities of daily living and employment, 40 will be left with disability requiring dependent care, and 10 will require institutionalization (2). Given the inadequacies of current available treatment for established infarction, our major effort must be directed toward stroke prevention through risk factor modification and proper application of appropriate medical and surgical therapies.Risk factors for stroke include hypertension, smoking, diabetes mellitus, cardiac disease, hyperlipidemia, transient ischemic attacks, and previous stroke. Sixty percent of all strokes are due to occlusion of a major brain vessel by thrombosis or embolism; data suggest that at least 60% are attributable to carotid disease (3).