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April 2, 1982

Carotid endarterectomy's value still uncertain

JAMA. 1982;247(13):1802-1803. doi:10.1001/jama.1982.03320380008004

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A six-year follow-up of patients undergoing carotid endarterectomy at the Mayo Clinic in Rochester, Minn, has revealed a reduction in stroke incidence that is "better than the natural history and better than alternative treatments."

Neurologists Jack P. Whisnant, MD, and Burton Sandok, MD, caution, however, that this good outcome was obtained under "ideal circumstances," adding: "You certainly can't extrapolate these results to all situations." Furthermore, even though morbidity from stroke appeared to be reduced, Whisnant concedes that "I'm not sure that we've improved the overall mortality, although the presumption is that we've decreased deaths from stroke."

Whisnant gave the report at the recent Joint International Conference on Stroke and Cerebral Circulation in New Orleans. Several other neurologists at the meeting underlined his caveats that these results could not be extrapolated to endarterectomy done at all hospitals and that the study does not prove that surgery alters the natural history of