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December 2, 1992

The Uncertainties Surrounding Carotid Endarterectomy

Author Affiliations

From the Department of Clinical Neurological Sciences, Robarts Research Institute, London, Ontario (Dr Barnett); the Department of Surgery, University of Arkansas, Little Rock (Dr Barnes); and the Department of Neurosurgery, University of Tennessee, Memphis (Dr Robertson).

JAMA. 1992;268(21):3120-3121. doi:10.1001/jama.1992.03490210102044

The year 1991 must rank as a vintage year for all physicians who care for patients at risk of ischemic stroke. Three of the most prestigious medical journals with the widest circulation published the results of multicenter trials that determined an unequivocal benefit of carotid endarterectomy for patients experiencing symptoms due to severe carotid artery disease.1-3

In these trials, surgery was compared with medical therapy: patients with recent focal symptoms in the brain or retina supplied by a stenosed carotid artery were randomly assigned to receive the best contemporary medical care alone or the same treatment with surgery added. Patients were not eligible if they had evidence of serious heart disease, other organ failure, or malignancy. One study was stopped after 3 years for patients with 70% stenosis or greater (defined as "severe") because of a clear difference in stroke-free survival between the medical and surgical groups.1 Patients