Carotid endarterectomies have been in use for more than 30 years. More than 100 000 patients underwent carotid endarterectomy in the United States in 1984, yet there are no standards based on outcomes for the appropriate use of this operation. In the perioperative period, the operation can produce the strokes and deaths it is designed to prevent. Are these complications more than offset by the number of strokes and deaths ultimately prevented by the operation? For patients operated on in centers with higher perioperative death rates, the available evidence favors medical treatment for many patient subgroups.1,2 However, for patients receiving optimal surgical care-meaning a combined perioperative stroke and death rate less than 5% — there is considerable uncertainty about the answer to this question. While three major randomized clinical trials are under way to settle the issue for some patient subgroups, this information will not be available for several
Wennberg JE. Setting Outcome-Based Standards for Carotid Endarterectomy. JAMA. 1986;256(18):2566–2567. doi:10.1001/jama.1986.03380180128036
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