title: Carotid artery surgery--critical analysis of indications in a regional Finnish vascular center.
abstract: BACKGROUND
  The purpose of this study was to analyze retrospectively the treatment of patients referred for carotid artery stenosis to a vascular surgical unit in the 1990's. Main attention was paid to the appropriateness of the indications for CEA.
  
  
  METHODS
  In the Pirkanmaa region (population of 440 000), all carotid surgery is performed in the regional University Hospital. All new referrals for vascular surgery because of carotid stenosis or bruit in 1990, 1992, 1994, 1996 and 1998 were included and case records reviewed.
  
  
  RESULTS
  Four hundred patients were referred. Indication for referral was a neurologic event in 46.2%, indefinite symptom in 27.9% and asymptomatic stenosis or carotid bruit in 25.9%. Most patients underwent carotid ultrasound as first imaging (93.7%). Almost half of the patients were operated (n=176). The 30-day combined stroke and death rate was 6.5%. Appropriate indication for CEA was found in 31.6%. Over half (57.0%) of the indications were considered uncertain and 11.4% inappropriate, most of these patients having asymptomatic stenosis.
  
  
  CONCLUSIONS
  Patients with asymptomatic stenosis underwent CEA relatively often and the proportion of inappropriate indications was too high. Evaluation of indications and perioperative complications is highly important in carotid surgery.
authors.affiliation: Department of Surgery, University Hospital, Tampere, Finland. mheik@netti.fi
authors.forename: M
authors.initials: M
authors.lastname: Heikkinen
authors.forename: J P
authors.initials: JP
authors.lastname: Salenius
authors.forename: R
authors.initials: R
authors.lastname: Zeitlin
authors.forename: J
authors.initials: J
authors.lastname: Saarinen
authors.forename: R
authors.initials: R
authors.lastname: Metsanoja
authors.forename: T
authors.initials: T
authors.lastname: Partio
authors.forename: O
authors.initials: O
authors.lastname: Auvinen
mesh_terms: D016893:Carotid Stenosis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000706:statistics & numerical data*; D005387:Finland / Q000453:epidemiology; D006801:Humans; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*