Carotid endarterectomy for prevention of stroke.
Carotid endarterectomy, a frequently performed operation, has been used as a strategy for preventing stroke in patients with carotid bifurcation disease. The safety and efficacy of the operation were recently challenged by a number of sources. Three major responses to this challenge were to retrospectively review the natural history of carotid bifurcation disease compared with the immediate and long-term results of carotid endarterectomy, to initiate 6 prospective randomized trials to determine the efficacy of carotid endarterectomy for a variety of indications, and to develop appropriateness initiatives and guidelines for using this surgical procedure by organizations concerned with health care policy. I review the current status of these 3 areas of endeavor. In those areas where studies are complete, carotid endarterectomy has been shown to be highly effective in reducing stroke risk. Risk reduction has ranged from 66% to 80% compared with medical management. Based on these sources and findings, I present a list of indications for the operation for surgeons who are able to do the operation safely and within the guidelines established by the Stroke Council of the American Heart Association.
Moore
W S
WS
Section of Vascular Surgery, University of California, Los Angeles, School of Medicine.
D002340:Carotid Artery Diseases / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000517:prevention & control*; D016894:Endarterectomy, Carotid; D006801:Humans; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors