Should be offered to appropriately selected patients

BMJ 1995;310:1136 (29 April)

Letters

Should be offered to appropriately selected patients

EDITOR,--Roger N Baird and Mark Lambert debate whether carotidendarterectomy should be purchased.¹ There is no doubt thatcarotid endarterectomy works.² Starting another trial in symptomaticpatients with tight stenoses would be unethical as the two largetrials in Europe and North America have proved beyond doubtthat this operation is highly successful.³ It is medically indefensiblenot to offer this operation to appropriate patients; if thesepatients are denied surgery then before long they will seekcompensation in the courts and will undoubtedly win. The questionbecomes, can the NHS afford the quality service that the treatmentof such patients requires?

Firstly, a prompt clinical assessment is required to make surethat only the right patients come to surgery. This requiresa careful history so that only those with appropriate symptomsare offered surgery.⁴ We run three cerebrovascular clinics aweek. About two patients in every 25 seen come . . . [Full text of this article]

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Controversies in Management: Should carotid endarterectomy be purchased? Treatment avoids much morbidity: Roger N Baird
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