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Can Carotid Endarterectomy Be Justified?

Can Carotid Endarterectomy Be Justified? Abstract To the Editor. —After 30 plus years of carotid endarterectomy, there is still no proof that even "in the best of hands" any patient group is afforded protection against stroke. What is incontrovertible is that carotid enderterectomy, as if penicillinlike, has become among the most frequent of operations that, nationwide, instead of protecting, is resulting in a net increase in stroke and death.There were 15000 carotid endarterectomies performed in 1975;85000 in 1982;103000 in 1984; and 107000 in 1985. Brott and Thalinger1 found that approximately half of these are performed for asymptomatic carotid disease. Whisnant2 estimates, from epidemiologic studies, that 76000 of the 103000 carotid endarterectomies performed in 1984 were likely unnecessary.In 1984, Dyken and Pokras3 reported that 2.8% of endarterectomy patients nationwide die before discharge from the hospital. Dyken4 remarked that "roughly 11.2% of those who have the operation die vs 2% References 1. Brott TG, Thalinger K: The practice of carotid endarterectomy in a large metropolitan area . Stroke 1984;15:950-955.Crossref 2. Whisnant JP: The role of the neurologist in the decline of stroke . Ann Neurol 1983;14:1-7.Crossref 3. Dyken ML, Pokras R: The performance of endarterectomy for disease of the extracranial arteries of the head . Stroke 1984;15:948-953.Crossref 4. Dyken ML: Address to American Heart Association, Sarasota, Fla, Jan 12-15, 1986. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Can Carotid Endarterectomy Be Justified?

Archives of Neurology , Volume 45 (7) – Jul 1, 1988

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1988.00520310016006
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor. —After 30 plus years of carotid endarterectomy, there is still no proof that even "in the best of hands" any patient group is afforded protection against stroke. What is incontrovertible is that carotid enderterectomy, as if penicillinlike, has become among the most frequent of operations that, nationwide, instead of protecting, is resulting in a net increase in stroke and death.There were 15000 carotid endarterectomies performed in 1975;85000 in 1982;103000 in 1984; and 107000 in 1985. Brott and Thalinger1 found that approximately half of these are performed for asymptomatic carotid disease. Whisnant2 estimates, from epidemiologic studies, that 76000 of the 103000 carotid endarterectomies performed in 1984 were likely unnecessary.In 1984, Dyken and Pokras3 reported that 2.8% of endarterectomy patients nationwide die before discharge from the hospital. Dyken4 remarked that "roughly 11.2% of those who have the operation die vs 2% References 1. Brott TG, Thalinger K: The practice of carotid endarterectomy in a large metropolitan area . Stroke 1984;15:950-955.Crossref 2. Whisnant JP: The role of the neurologist in the decline of stroke . Ann Neurol 1983;14:1-7.Crossref 3. Dyken ML, Pokras R: The performance of endarterectomy for disease of the extracranial arteries of the head . Stroke 1984;15:948-953.Crossref 4. Dyken ML: Address to American Heart Association, Sarasota, Fla, Jan 12-15, 1986.

Journal

Archives of NeurologyAmerican Medical Association

Published: Jul 1, 1988

References