Endarterectomy in the news

Who’s likely to benefit from endarterectomy?

A risk-modeling approach proposed by a group of British investigators could improve the benefits of carotid endarterectomy while reducing its risks. Although endarterectomy is considered the treatment of choice for patients with symptomatic, 70% to 99% carotid stenosis, only a fifth of those patients have a stroke in the three years following symptom onset with medical therapy alone. Therefore, surgery is of no value in 80%, point out the authors of a recent British study.¹

In order to identify patients most likely to benefit, the investigators stratified nearly 1,000 patients with 70% to 99% carotid stenosis and developed a risk-scoring system based on seven independent prognostic factors. Carotid endarterectomy reduced the five-year risk of stroke in the area supplied by the carotid artery in high-risk patients — 16% — by a third and had no significant benefit in patients at lower risk. In lowest-risk patients, endarterectomy was potentially harmful, the authors note. Their findings suggest that by operating on this small identifiable subgroup of patients with a high risk of stroke and a low operative risk, stroke can be prevented in as many patients as by operating on all those with 70% to 99% stenosis. Although the authors conclude that the risk-modeling approach appears useful, they point out that further refinements and validation of the model are needed.

Reference

1. Rothwell PM, et al., on behalf of the European Carotid Surgery Trialists’ Collaborative Group. Prediction of benefit from carotid endarterectomy in individual patients: A risk-modelling study. Lancet 1999; 353:2,105-2,110.