High rate of inappropriate carotid endarterectomy in an urban medical center.
BACKGROUND
Some studies have reported that the appropriateness of carotid endarterectomy (CEA) has dramatically improved in the last two decades. However, these studies did not include the most recent study results for asymptomatic stenosis.


METHODS
We sought to determine the appropriateness of CEA at a large, urban community hospital. A retrospective chart review of all CEA procedures during a 2-year period was conducted. CEA appropriateness was defined according to factors including age, degree of stenosis, symptomatic or asymptomatic status, and presence of high surgical risk comorbidities.


RESULTS
During a 2-year period, 51 CEA procedures were performed. For patient characteristics, 73% were asymptomatic, 77% were African American, and 65% had high surgical risk comorbidities. Perioperative stroke or myocardial infarction occurred in 14.3% of symptomatic patients and 18.9% of asymptomatic patients. The rate of inappropriate CEA was 57%, and 14% of cases were of uncertain value. Patients with an inappropriate or uncertain CEA had a 19.4% rate of in-hospital stroke or myocardial infarction.


CONCLUSIONS
In an urban hospital, the majority of CEA procedures were either inappropriate or of uncertain value. The periprocedure complication rate was high in these patients. Patient selection in urban hospitals is not adhering to clinical trial criteria.
Kapadia
Manish
M
Stroke Program and Department of Neurology, Wayne State University, Detroit, Michigan 48201, USA.
Mehri-Basha
Maysaa
M
Madhavan
Ramesh
R
Rajamani
Kumar
K
Chaturvedi
Seemant
S
D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D015897:Comorbidity; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data* / Q000639:trends