Indications for Carotid Endarterectomy: Surgeons vs Neurologists

Abstract

The purpose of this study was to evaluate the indications for carotid endarterectomy (CEA) in the authors' geographic area and compare responses of vascular surgeons and neurologists. Results were also compared with the recommendations of the Rand panel. Vascular surgeons and neurologists agreed that multiple transient ischemic attacks (TIA) in patients receiving medical treatment and in those with crescendo ischemic attacks were appropriate indications for endarterectomy. However, surgeons favored CEA significantly more (p < 0.0001) than neurologists for other symptomatic patients. No agreement could be found between surgeons and neurologists for endarterectomy in patients with asymptomatic carotid disease. Although a national panel of experts has identified appropriate indications for CEA, the authors' medical community (Eastern Pennsylvania) has significant variations when responses of vascular surgeons and neurologists are compared. Therefore, patient treatment depends mainly on the referral patterns of the primary care physician. Further prospective studies are required to achieve unanimity regarding indications for this operation.