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Title: Carotid Endarterectomy
Agency: Agency for Health Care Policy and Research/Center for
Health Care Technology (formerly the Office of
Health Technology Assessment)
Contact: Harry Handelsman, D.O., Medical Officer; Thomas V.
Holohan, M.D., Director, CHCT
Status: Technology Assessment: Published, 1991
Primary Objective: Scientific evaluation of the clinical
effectiveness of carotid endarterectomy for the Health Care
Financing Administration's Medicare coverage policy.
Methods Used: Synthesis of published literature, information
solicited from professional societies and organizations with
interest or experience with this technology, and consultation
with U.S. Public Health Service, (NIH and FDA).
Data Identification: English language journal articles and
textbooks published between 1970 and 1989 available through the
search capabilities of the National Library of Medicine. Key
words: Carotid artery disease, carotid endarterectomy, carotid
stenosis, carotid bruit.
Study Selection: A: All published studies reporting operative
morbidity and mortality (10). B: All published studies (14)
reporting perioperative stroke and death rates, and annual stroke
rates during followup.
Data Extraction: Outcomes of carotid endarterectomy in published
Key Results/Findings: Studies testing the efficacy of the
procedure and documenting its associated morbidity and mortality
have until now produced conflicting results. Only the current
NIH trial has demonstrated carotid endarterectomy to be better
than nonoperative management of symptomatic patients with high-grade stenosis. However, there has been no definitive study
concluding that asymptomatic patients benefit from carotid
Conclusions/Options: There is a need to better identify other
subsets of patients who are most likely to benefit from carotid
endarterectomy. It is hoped that the controversies concerning
this technique in asymptomatic patients and in symptomatic
patients with less than high-grade stenosis will be resolved by
the current clinical trials.