Carotid endarterectomy vs. medical management: the time is ripe for re-examination

Academy Health: 12/19/12

Carotid atherosclerosis results in narrowing of the carotid arteries as plaque builds up along artery walls and at the carotid bifurcation.  This narrowing (stenosis) is associated with increased risk of stroke when it progresses into the 50% to 99% range.  Carotid endarterectomy (CEA) is a surgical procedure frequently used to reduce the risk of stroke by opening carotid arteries.  The procedure is not without risk, however: a small but substantial minority of CEA patients suffer a perioperative stroke. This begs the question whether CEA outcomes are better or worse than medical management. For reasons explained below, this question is ripe for comparative effectiveness research.

By way of full disclosure, I am a co-investigator on an observational study of CEA vs. medical management funded by the Department of Veterans Affairs’ Health Services Research & Dissemination service. My co-investigators are Steven Pizer (PI), Scott Kinlay, Graeme Fincke, Michael McWilliams, and Bruce Landon. Though based on the work of the group, what follows are my views and does not necessarily reflect the position or policy of the Department of Veterans Affairs, my co-investigators, or the other institutions with which they or I am affiliated. Read more