A severe, nonfatal stroke has a ruinous effect on the quality of life, and the evidence suggests that carotid endarterectomy can prevent stroke in selected patients, as I will try to show. Choosing both the proper patient and a skilled surgeon is the key to achieving this goal.
Who is the proper patient? Certainly not the entire pool of patients with asymptomatic bruit. Two studies suggest that the stroke rate is approximately 2% per annum in this group.1,2 Patients with an asymptomatic bruit face a greater threat of death than they do of stroke, since their annual mortality rate is approximately 4%. Between the low incidence of stroke and a significant mortality rate from causes such as heart disease, it is not likely that the routine performance of carotid endarterectomy in unselected patients with asymptomatic bruit could be shown to be beneficial by any kind of a randomized trial.
Patterson RH. Can Carotid Endarterectomy Be Justified? Yes. Arch Neurol. 1987;44(6):651–652. doi:10.1001/archneur.1987.00520180069019
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