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Carotid Endarterectomy

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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

Language: English

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 studies (1970-1989).

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 endarterectomy.

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.

The information on this page is archived and provided for reference purposes only.

 

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