CEA in practice

Feasby TE and Barnett HJM. Improving the appropriateness of carotid endarterectomy (editorial). Neurology 2007;68:172-173. Based on 2 articles within

Cutting to the chase, the article reminds us that the NTT (number to treat) to prevent a stroke for symptomatic stenotic carotid arteries is 7.6 over two years, v. 67 for asymptomatic carotid stenoses. The risk reduction correspondingly is 13.1 % and 1.5 % respectively.

The articles suggest that due to the publication of data, that inappropriate CEA is reduced, but one in 10 is still inappropriate, due to patients being too sick, too recent strokes, or only minor carotid stenosis. However, the major reason is that more CEA's are being done for asymptomatic carotid stenosis. Almost 3/4 of patients were asymptomatic. The national complication rate is between 3.5 and 4.5 percent of RECORDED complications. The trend is concerning.

Separately, my old friend Rich Dubinsky found that combined stroke/death rates among patients undergoing combined CEA/CABG was 38 %, leading to concern about the combined procedure for carotid artery stenosis that is asymptomatic..