Operation to Prevent Stroke Often Abused, Panel Claims

A controversial operation designed to reduce the chances of suffering a stroke is used for inappropriate or questionable reasons in many cases, according to researchers at UCLA and RAND Corp. in Santa Monica.

They had asked a panel of nationally known experts to evaluate a random sample of 1,302 Medicare patients who underwent the procedure, known as carotid endarterectomy, in 1981.

The panel determined that 32% of the patients underwent the procedure for “inappropriate reasons,” while another 32% were performed for ambiguous reasons, the researchers reported in the New England Journal of Medicine.

“We conclude that carotid endarterectomy was substantially overused in the three geographic areas we studied,” the researchers said.

More than 100,000 Americans undergo the surgery each year. The operation involves cutting open the patient’s neck and carotid artery and scraping out blockage that could cut off blood flow to the brain, causing a stroke.

A number of studies have recently questioned the usefulness of the operation, finding that the risk of suffering a stroke or dying due to the surgery may outweigh the benefits in many cases.

In the new study, 48% of the operations deemed inappropriate were performed on patients who had little blockage and 54% were performed on patients who had not experienced symptoms that placed them at the highest risk for a stroke.

Eleven percent of the patients whose operations were considered inappropriate were at high risk for suffering a heart attack or cardiac arrest during surgery.

Nearly 10% of the patients suffered major complications, such as death or a stroke, the researchers said. “Moreover, because of the high rate of complications, carotid endarterectomy may not benefit even patients who are operated on for appropriate indications.”

The researchers noted that since 1981, doctors may have gained a better understanding of which types of patients might be most suitable to undergo the operation.

But they added, “We believe that our findings raise important questions about the use of carotid endarterectomy in elderly patients.