Stroke Prevention Surgery
DALLAS (Ivanhoe Newswire) -- One in 10 surgeries to clear blocked arteries to the brain for stroke prevention may be unnecessary, finds a new study reported in the journal Stroke.
A procedure called carotid endarterectomy removes plaque in the arteries of the neck that supply blood to the brain, thereby decreasing a chance of stroke. Studies in the 1990s found these artery clearing surgeries were overused. After that the number of inappropriate surgeries dropped from 32 percent in the 1980s to 10.6 percent between 1997 and 1998.
Ethan A. Halm, M.D., M.P.H., from Mt. Sinai School of Medicine in New York, developed a list of 1,557 indications for the surgery and asked a panel of national experts to rate the appropriateness of each. The ratings were used to assess the appropriateness of surgery in 2,124 patients who underwent the procedure between 1997 and 1998.
"The bad news is that one in 10 operations are still done in situations where the risks may outweigh the benefits. If our results are typical of practice in the United States, then about 14,000 operations are performed annually for inappropriate reasons," says Dr. Halm.
Researchers also found the type of patient receiving the surgery has shifted. The procedure was originally developed to prevent strokes in patients with neurologic symptoms, but three quarters were done in asymptomatic patients. This is a concern because even though asymptomatic patients have vessel narrowing, they have less to gain than a patient with neurologic symptoms.
In conclusion, researchers say surgery is considered appropriate when the benefits exceed the risks of the procedure.
This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.
SOURCE: To be published in an upcoming issue of Stroke
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