Appropriate Use of Carotid Endarterectomy

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Abstract
The use of carotid endarterectomy is on the rise again. After a six-year decline, the number of such operations rose by 94 percent between 1991 and 1996. As shown in Figure 1, however, this has happened before: between 1980 and 1985, the incidence rose by 95 percent. The initial enthusiasm for the procedure was dampened by reports of high complication rates, questions about the appropriateness of patients selected to undergo the procedure, and the absence of rigorous clinical studies demonstrating the efficacy of the operation. What followed was a remarkable feat in research. A series of large and complex randomized, controlled . . .