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October 14, 1998

Outcomes After Carotid Endarterectomy—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(14):1228-1229. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-14-jbk1014

In Reply.—As Dr Chaturvedi correctly observes, the reported 30-day mortality rate of 1.8% pertained to our entire sample, including patients who underwent surgery for transient ischemic attack or stroke. The overall 30-day rate for stroke or death in asymptomatic patients was 2.4%, as reported in our Table 2, which is below the 3% maximum acceptable operative stroke or death rate recommended by the American Heart Association Stroke Council1 and reinforced in the guidelines of an American Heart Association ad hoc committee on carotid endarterectomy.2 Further, while this rate is somewhat higher than the 1.5% rate observed in ACAS, we highlighted in our results the wide variation in outcome by hospital volume, ranging from 0% among patients undergoing surgery at higher-volume hospitals to 4.9% among those at lower-volume hospitals. While it was not our purpose to recommend CE for asymptomatic stenosis, as implied by Chaturvedi, neither do we believe that appropriately selected patients should be denied surgery, if a surgeon and institution can document acceptably low complication rates, such as those observed in Ohio's higher-volume hospitals.

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