High Rate of Inappropriate Carotid Endarterectomy in an Urban Medical Center

Manish Kapadia, Maysaa Mehri-Basha, Ramesh Madhavan, Kumar Rajamani, Seemant Chaturvedi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Some studies have reported that the appropriateness of carotid endarterectomy (CEA) has dramatically improved in the last two decades. However, these studies did not include the most recent study results for asymptomatic stenosis. Methods: We sought to determine the appropriateness of CEA at a large, urban community hospital. A retrospective chart review of all CEA procedures during a 2-year period was conducted. CEA appropriateness was defined according to factors including age, degree of stenosis, symptomatic or asymptomatic status, and presence of high surgical risk comorbidities. Results: During a 2-year period, 51 CEA procedures were performed. For patient characteristics, 73% were asymptomatic, 77% were African American, and 65% had high surgical risk comorbidities. Perioperative stroke or myocardial infarction occurred in 14.3% of symptomatic patients and 18.9% of asymptomatic patients. The rate of inappropriate CEA was 57%, and 14% of cases were of uncertain value. Patients with an inappropriate or uncertain CEA had a 19.4% rate of in-hospital stroke or myocardial infarction. Conclusions: In an urban hospital, the majority of CEA procedures were either inappropriate or of uncertain value. The periprocedure complication rate was high in these patients. Patient selection in urban hospitals is not adhering to clinical trial criteria.

Original languageEnglish (US)
Pages (from-to)277-280
Number of pages4
JournalJournal of Stroke and Cerebrovascular Diseases
Volume18
Issue number4
DOIs
StatePublished - Jul 2009
Externally publishedYes

Fingerprint

Carotid Endarterectomy
Urban Hospitals
Comorbidity
Pathologic Constriction
Stroke
Myocardial Infarction
Age Factors
Community Hospital
African Americans
Patient Selection
Clinical Trials

Keywords

  • African Americans
  • Carotid endarterectomy
  • Carotid Stenosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine

Cite this

High Rate of Inappropriate Carotid Endarterectomy in an Urban Medical Center. / Kapadia, Manish; Mehri-Basha, Maysaa; Madhavan, Ramesh; Rajamani, Kumar; Chaturvedi, Seemant.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 18, No. 4, 07.2009, p. 277-280.

Research output: Contribution to journalArticle

Kapadia, Manish ; Mehri-Basha, Maysaa ; Madhavan, Ramesh ; Rajamani, Kumar ; Chaturvedi, Seemant. / High Rate of Inappropriate Carotid Endarterectomy in an Urban Medical Center. In: Journal of Stroke and Cerebrovascular Diseases. 2009 ; Vol. 18, No. 4. pp. 277-280.
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