Education And Debate

Controversies in Management: Should carotid endarterectomy be purchased? Treatment avoids much morbidity

BMJ 1995; 310 doi: (Published 04 February 1995) Cite this as: BMJ 1995;310:316
  1. Roger N Baird, consultant surgeona
  1. a Department of Surgery, Bristol Royal Infirmary

    A neurologist writing in 1978 on the treatment he would want if he had a transient ischaemic attack advised that the blood pressure should be checked and investigations instituted to prevent further ischaemic attacks which might culminate in stroke or death.1 The article did not mention health gain and cost, because in 1978 disease based healthcare purchasing was confined to a few underexploited treatments. Health purchasers today, however, have to judge the value of carotid endarterectomy against other attempts to reduce the burden of morbidity from stroke. These include screening for and control of hypertension, antiplatelet therapy using aspirin, and rehabilitation and caring for people who have had a stroke.

    Scientific evaluation

    The prognosis of transient ischaemic attacks was recently studied in 184 patients from 10 group practices in Oxfordshire, and the risk of stroke was 11.6% during the first year, rising to 29.3% within five years.2 Carotid endarterectomy has the greatest benefit for patients with transient ischaemic attacks of the brain and eye who have a greater than 70% stenosis at the origin of the relevant internal carotid artery in the neck. …

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