Journal ArticleDOI
The Appropriateness of Carotid Endarterectomy
Constance M. Winslow,David H. Solomon,Mark R. Chassin,Jacqueline Kosecoff,Nancy J. Merrick,Robert H. Brook +5 more
TLDR
The appropriateness of carotid endarterectomy was determined in a random sample of 1302 Medicare patients in three geographic areas who had had the procedure in 1981 by a panel of nationally known experts using a modified Delphi technique.Abstract:
Carotid endarterectomy is a commonly performed but controversial procedure. We developed from the literature a list of 864 possible reasons for performing carotid endarterectomy, and asked a panel of nationally known experts to rate the appropriateness of each indication using a modified Delphi technique. On the basis of the panel's ratings, we determined the appropriateness of carotid endarterectomy in a random sample of 1302 Medicare patients in three geographic areas who had had the procedure in 1981. Thirty-five percent of the patients in our sample had carotid endarterectomy for appropriate reasons, 32 percent for equivocal reasons, and 32 percent for inappropriate reasons. Of the patients having inappropriate surgery, 48 percent had less than 50 percent stenosis of the carotid artery that was operated on. Fifty-four percent of all the procedures were performed in patients without transient ischemic attacks in the carotid distribution. Of these procedures, 18 percent were judged appropriate, as compared with 55 percent judged appropriate in patients with transient ischemic attacks in the carotid distribution. After carotid endarterectomy, 9.8 percent of patients had a major complication (stroke with residual deficit at the time of hospital discharge or death within 30 days of surgery). We conclude that carotid endarterectomy was substantially overused in the three geographic areas we studied. Furthermore, in situations in which the complication rate is equal to or above the study's aggregate rate, carotid endarterectomy would not be warranted, even in cases with an appropriate indication, because the risks would almost certainly outweigh the benefits.read more
Citations
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Journal ArticleDOI
Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators.
H.J.M. Barnett,D W Taylor,Michael Eliasziw,Allan J. Fox,Gary G. Ferguson,Richard Haynes,R N Rankin,G. P. Clagett,Vladimir Hachinski,David L. Sackett,Kevin E. Thorpe,Heather Meldrum,J. D. Spence +12 more
TL;DR: Benefit of carotid endarterectomy was greatest among men, patients with recent stroke as the qualifying event, and patients with hemispheric symptoms, and decisions about treatment for patients in this category must take into account recognized risk factors.
Journal ArticleDOI
Carotid Endarterectomy and Prevention of Cerebral Ischemia in Symptomatic Carotid Stenosis
Marc R. Mayberg,Samuel E. Wilson,F. Yatsu,D G Weiss,Louis M. Messina,L A Hershey,C Colling,Joseph M. Eskridge,D Deykin,H R Winn +9 more
TL;DR: In this article, Carotid endarterectomy was used to prevent subsequent cerebral ischemia in men with ischemic symptoms in the distribution of significant (>50%) ipsilateral internal carotid artery stenosis.
Journal Article
Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. Commentary
TL;DR: For a selected cohort of men with symptoms of cerebral or retinal ischemia in the distribution of a high-grade internal carotid artery stenosis, carOTid endarterectomy can effectively reduce the risk of subsequent ipsilateral cerebral ischemies.
Journal ArticleDOI
Elective Stenting of the Extracranial Carotid Arteries
Jay S. Yadav,Gary S. Roubin,Sriram S. Iyer,Jiri J. Vitek,Peter H. King,William D. Jordan,Winfield S. Fisher +6 more
TL;DR: In this article, the feasibility and safety of percutaneous carotid angioplasty and elective stenting was evaluated prospectively in a consecutive series of 107 patients, including patients with previous ipsilateral endarterectomy and severe medical comorbidity.
Journal ArticleDOI
Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase
Robert W. Hobson,Virginia J. Howard,Gary S. Roubin,Thomas G. Brott,Robert D. Ferguson,Jeffrey J. Popma,Darlene L. Graham,George Howard +7 more
TL;DR: Interim results from the lead-in phase of CREST show that the periprocedural risk of stroke and death after CAS increases with age in the course of a credentialing registry.
References
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Multifactorial Index of Cardiac Risk in Noncardiac Surgical Procedures
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Journal ArticleDOI
Does inappropriate use explain geographic variations in the use of health care services? A study of three procedures.
Mark R. Chassin,Jacqueline Kosecoff,Rolla Edward Park,Constance M. Winslow,Katherine L. Kahn,Nancy J. Merrick,Joan Keesey,Arlene Fink,David H. Solomon,Robert H. Brook +9 more
TL;DR: It is concluded that differences in appropriateness cannot explain geographic variations in the use of these procedures.
Journal ArticleDOI
Variations in the Use of Medical and Surgical Services by the Medicare Population
Mark R. Chassin,Robert H. Brook,Rolla Edward Park,Joan Keesey,Arlene Fink,Jacqueline Kosecoff,Katherine L. Kahn,Nancy J. Merrick,David H. Solomon +8 more
TL;DR: Large and significant differences in the use of medical and surgical services during 1981 by Medicare beneficiaries (age greater than or equal to 65) in 13 large areas of the United States are found.
Journal ArticleDOI
Outcome in Patients with Asymptomatic Neck Bruits
Brian R. Chambers,John W. Norris +1 more
TL;DR: The degree of carotid-artery stenosis on initial presentation was a powerful predictor of neurologic sequelae and patients with asymptomatic cervical bruits have a higher risk of a cardiac ischemic event than of a stroke.