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Page: << Prev | 1 | 2 The combined rate of stroke and heart attack at the time of carotid endarterectomy was 11.3 percent, which is more than three times the expected rate of 3.5 percent. Chaturvedi noted that many patients were over 75, and most of the heart attacks and strokes occurred in this group.
Before doing this procedure, doctors should be sure that patients, particularly black patients, have their blood pressure controlled. "I would be a little hesitant about operating on the asymptomatic ones, because those are the patients who have the most narrow risk/benefit ratio, especially the asymptomatics over 75. I would probably refrain from operating on them," Chaturvedi said.
Chaturvedi also said that practice makes perfect, so that the more a doctor does the procedure, the better he or she gets. Likewise, the more procedures a hospital does, the lower the risk of complications. For example, the hospital that did 99 procedures had fewer problems than the one that did only 51, he said.
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One expert believes the procedure is too risky for patients with asymptomatic carotid artery disease.
"That the results are worse in the real world than in a selected clinical trial population may also apply to populations that are not African-American," said Dr. Vladimir Hachinski, a professor of neurology at the University of Western Ontario, London, Canada. "It wouldn't be surprising if the real figures are closer to Detroit than reported clinical trials."
"The procedure is more dangerous than reported," Hachinski said. "It's particularly dangerous in asymptomatic carotid disease, where any gain is marginal, because the risk of having a stroke from asymptomatic carotid disease is only 2 to 3 percent a year," he added.
Hachinski said his hospital does not perform the procedure on asymptomatic patients.
The Canadian expert also believes that before they have a carotid endarterectomy, patients should gather a lot of information about the risk vs. the benefits. They should also investigate the experience and the success rate of their doctor and their hospital.
"Ask what the statistics are for that hospital," Hachinski said. "Show me the money--what are my odds?"
More information
There's more on carotid endarterectomy at the American Heart Association.
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