Variation in Carotid Endarterectomy Mortality in the Medicare Population

Abstract

SINCE 1990, several randomized trials comparing carotid endarterectomy (CEA) with medical therapy for atherosclerotic narrowing of the bifurcation of the common carotid artery have been published.^1-6 The 2 largest trials in the United States, the North American Symptomatic Carotid Endarterectomy Trial (NASCET)⁷ and the Asymptomatic Carotid Atherosclerosis Study (ACAS),⁸ were discontinued early when the beneficial outcomes in the surgical arms crossed the threshold required to invoke the respective trial's "stop rule." The National Institutes of Health released the preliminary results via "clinical alerts" to physicians.^9,10 These alerts suggested that CEA is the preferred treatment for both symptomatic and asymptomatic patients with carotid artery disease if the procedures are performed in centers with low risk of perioperative stroke and death.