BMJ 1995;310:1135 (29 April)

Letters

Is cost effective

EDITOR,--Roger N Baird and Mark Lambert are correct in stating that prevention of stroke is an important public health issue.1 There is now good evidence that treating hypertension in older patients, giving anticoagulants to patients with atrial fibrillation, and prescribing aspirin to patients with minor ischaemic stroke and transient ischaemic attacks reduces rates of stroke and costs. Lambert suggests, however, that only 154 strokes are preventable by carotid surgery among the 20500 patients presenting to their general practitioners with transient ischaemic attacks each year. He ignores a similar number of patients with minor ischaemic strokes due to carotid disease. The Association of British Neurologists estimates that 500 strokes are preventable by carotid surgery.2

Lambert is right to highlight the cost and risk of carotid angiography. Use of this invasive and expensive technique as the primary investigation of carotid disease must be discouraged. Our stroke prevention clinic uses colour flow duplex . . . [Full text of this article]


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Relevant Article

Controversies in Management: Should carotid endarterectomy be purchased? Treatment avoids much morbidity
Roger N Baird
BMJ 1995 310: 316-317. [Extract] [Full Text]

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