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April 24, 1987

The Appropriateness of Carotid Endarterectomy

Author Affiliations

University of Southern California School of Medicine Los Angeles

University of Southern California School of Medicine Los Angeles

JAMA. 1987;257(16):2166-2167. doi:10.1001/jama.1987.03390160052020

To the Editor.—  The recent article entitled "Use of Carotid Endarterectomy in Five California Veterans Administration Medical Centers" by Merrick et al1 concluded that carotid endarterectomy is overutilized within some segments of the Veterans Administration patient population. This conclusion was obtained following a retrospective review of the records of 95 patients in five Veterans Administration hospitals who underwent 107 carotid endarterectomies for a variety of indications in 1981.The appropriateness or inappropriateness of such intervention was determined by the application of the Rand/ UCLA Health Services Utilization Study (HSUS) on indications for carotid endarterectomy. The authors' intent was to determine whether this high-cost procedure was being utilized appropriately or overutilized. In this context, indications for carotid endarterectomies performed were found to be appropriate in 55% of patients, equivocal in 32%, and inappropriate in 13%.Although the authors' intention was worthwhile, the conclusions reached by Merrick and colleagues are suspect