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July 1988

Can Carotid Endarterectomy Be Justified?

Author Affiliations

5565 Grossmont Center Dr Bldg 1, Suite 206 La Mesa, CA 92041

Arch Neurol. 1988;45(7):714-715. doi:10.1001/archneur.1988.00520310016006

To the Editor.  —After 30 plus years of carotid endarterectomy, there is still no proof that even "in the best of hands" any patient group is afforded protection against stroke. What is incontrovertible is that carotid enderterectomy, as if penicillinlike, has become among the most frequent of operations that, nationwide, instead of protecting, is resulting in a net increase in stroke and death.There were 15000 carotid endarterectomies performed in 1975;85000 in 1982;103000 in 1984; and 107000 in 1985. Brott and Thalinger1 found that approximately half of these are performed for asymptomatic carotid disease. Whisnant2 estimates, from epidemiologic studies, that 76000 of the 103000 carotid endarterectomies performed in 1984 were likely unnecessary.In 1984, Dyken and Pokras3 reported that 2.8% of endarterectomy patients nationwide die before discharge from the hospital. Dyken4 remarked that "roughly 11.2% of those who have the operation die vs 2%

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