BMJ 1995;310:1136 (29 April)

Letters

Preoperative angiography is outdated

EDITOR,--I am surprised that Mark Lambert should minimise the impact of carotid endarterectomy1 as its benefits have been more than proved in randomised controlled studies. Much of his criticism seems to hinge on his contention that angiography causes stroke in 1% of patients and that if this figure is added to the surgical morbidity and mortality the whole thing becomes worthless. He does not seem to accept or understand that most centres these days do not perform angiography before carotid endarterectomy. In my centre, for example, we have performed angiography in few cases in the past seven years and operate on many patients with carotid stenosis. Duplex scanning is all that is required in most cases and has no mortality.

Lambert mentions that, of over 97000 strokes each year, only 154 can be prevented by carotid endarterectomy. He fails to mention that the remaining cases (>96000) cannot be prevented, even . . . [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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