Indications, Outcomes, and Provider Volumes for Carotid Endarterectomy

Abstract

DURING THE PAST decade, several controlled trials have provided evidence that carotid endarterectomy is superior to best medical therapy in reducing subsequent stroke rates among important subgroups of persons at risk.^1-4 Studies in North America and Europe^1,2 demonstrated a beneficial effect of carotid endarterectomy among symptomatic persons who have high-grade ipsilateral carotid artery stenosis. Publication of the Asymptomatic Carotid Atherosclerosis Study (ACAS) in 1995⁴ broadened the potential indications for carotid endarterectomy to include asymptomatic patients with high-grade carotid artery stenosis, raising the possibility of a 10-fold increase in the performance of the procedure.^5,6