title: Variability in carotid endarterectomy practice patterns within a metropolitan area.
abstract: OBJECTIVE
  Previous clinical studies have suggested that patients with carotid stenosis with high surgical risk features may fare better with carotid artery stenting or aggressive medical therapy. The extent to which carotid endarterectomy is still being performed in this group of patients is unclear.
  
  
  METHODS
  A retrospective audit was performed among 4 hospitals over a 2-year period. The proportion of high surgical risk patients was compared and the in-hospital stroke, myocardial infarction, and death rates were compared among conventional and high surgical risk patients.
  
  
  RESULTS
  Three hundred thirty-five carotid endarterectomy operations were performed (63% asymptomatic) with 37.9% being high surgical risk subjects. The stroke, myocardial infarction, and death rate was 4.6% in conventional risk subjects and 10.2% in high surgical risk patients (P<0.05). The only hospital with multidisciplinary carotid conferences had the lowest proportion of carotid endarterectomy operations in asymptomatic patients.
  
  
  CONCLUSIONS
  A substantial proportion of carotid endarterectomy operations are performed in patients with high surgical risk features. These patients experienced a 2-fold increase in major in-hospital complications, raising doubts about whether they benefit from carotid surgery. The use of preintervention multidisciplinary conferences may improve patient safety.
authors.affiliation: Department of Neurology, Wayne State University, Henry Ford Hospital, 8-C-UHC, 4201 St Antoine, Detroit, MI 48201, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Kansara
authors.forename: Daniel
authors.initials: D
authors.lastname: Miller
authors.forename: Rahul
authors.initials: R
authors.lastname: Damani
authors.forename: Darren
authors.initials: D
authors.lastname: Fuerst
authors.forename: Brian
authors.initials: B
authors.lastname: Silver
authors.forename: Seemant
authors.initials: S
authors.lastname: Chaturvedi
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors