Research is not clear on the benefit of endarterectomy if
you have carotid stenosis (narrowing) of 50% to 69% and symptoms, such as a
previous TIA or mild stroke. For this group, studies have shown that
endarterectomy provides moderately better results than treatment with medicine. But the results of these studies have been highly debated.1
Several things affect whether
endarterectomy for these people works better than treatment with medicine.
One important factor is the skill of the surgeon. Research suggests that the
surgeon doing the endarterectomy should have a low complication rate of no
more than 6% for this procedure to be considered beneficial for his or her
patients. Complication rates higher than 6% negate the potential benefit of
stroke risk reduction. In other words, you are more likely to have
complications from the surgery than to benefit from long-term stroke risk
To find your surgeon's complication rate, check with
his or her office, the hospital where the surgery will be performed, and your
state's medical association. Access to this information may vary by
Another measure of stroke risk reduction for this procedure
is with the hospital itself. In general, larger hospitals and regional medical
centers have staffs that are more experienced in doing carotid
endarterectomies than those in smaller hospitals. Check to see how many carotid
endarterectomies are done in your hospital each year.
things that affect outcomes of surgery on this group include age, gender,
other health problems, and the severity of the TIA or stroke. For example,
women in this category don't seem to benefit from endarterectomy. They may have
more problems related to surgery than men.
Rerkasem K, Rothwell PM (2011). Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database of Systematic Reviews (4).
Furie KL, et al (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(1): 227–276. Also available online: http://stroke.ahajournals.org/content/42/1/227.full.
January 3, 2013
E. Gregory Thompson, MD - Internal Medicine
& Karin M. Lindholm, DO - Neurology
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