This letter is in response to the article in the December 2002 issue by Feasby et al1 and the editorial by Dr Barnett.2 Although the appropriate reaction to this study might support Dr Barnett's recommendations, the restriction of endarterectomy by volume creates the conundrum of how one manages to accumulate the requisite number of surgical procedures per year as one begins a career in surgery. Do the procedures done in training count? It also creates the problem of how a given hospital might begin to do such procedures or increase its numbers if a regulatory process prevents it from doing so.
Pittman G. Carotid Endarterectomy: Turning Up the Volume? Arch Neurol. 2004;61(2):296. doi:10.1001/archneur.61.2.296-c
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