The number of carotid endarterectomies performed in North America continues to climb despite inconclusive1 or failed2 attempts to prove its effectiveness. The estimated overall mortality and morbidity from the operation in the United States exceeds that of the natural history of carotid artery disease.3
The statement that too many carotid endarterectomies are being performed would hardly fuel a controversy. What remains arguable is Dr Patterson's conclusion that "carotid surgery has an important role in the prevention of stroke" and Dr Jonas' assertion that "the procedure is... not justified for general use on the basis of the evidence presently available." Dr Patterson quotes the apparent decreased stroke risk of patients surviving carotid endarterectomy without a stroke. The difficulty with this interpretation is that carotid endarterectomy may precipitate stroke or death in those most prone, leaving a select group of survivors who may have had a better prognosis, even
Hachinski V. Carotid Endarterectomy. Arch Neurol. 1987;44(6):654. doi:10.1001/archneur.1987.00520180072021
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