Endarterectomy for Stenosis of 50% to 69% With Symptoms

Research is not clear on the benefit of endarterectomy if you have carotid stenosis (narrowing) of 50% to 69% and symptoms, such as a previous TIA or mild stroke. For this group, studies have shown that endarterectomy provides moderately better results than treatment with medicine. But the results of these studies have been highly debated.^{Reference 1}

Several factors affect whether endarterectomy for these people is more effective than treatment with medicine. One important factor is the skill of the surgeon. Research suggests that the surgeon doing the endarterectomy should have a low complication rate of no more than 6% for this procedure to be considered beneficial for his or her patients. Complication rates higher than 6% negate the potential benefit of stroke risk reduction. In other words, you are more likely to have complications from the surgery than to benefit from long-term stroke risk reduction.^{Reference 2}

To find your surgeon's complication rate, check with his or her office, the hospital where the surgery will be performed, and your state's medical association. Access to this information may vary by state.

Another measure of stroke risk reduction for this procedure is with the hospital itself. In general, larger hospitals and regional medical centers have staffs that are more experienced in doing carotid endarterectomies than those in smaller hospitals. Check to see how many carotid endarterectomies are done in your hospital each year.

Other things that influence outcomes of surgery on this group include age, gender, other health problems, and the severity of the TIA or stroke. For example, women in this category don't seem to benefit from endarterectomy and may have more problems related to surgery than men.

Citations

1. Biller J, et al. (1998). Guidelines for carotid endarterectomy: A statement for healthcare professionals from a special writing group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501–509.

2. Furie KL, et al. (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online October 21, 2010 (doi: 10.1161./STR.0b013e3181f7d043).

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