BMJ 1995;310:1136 (29 April)

Letters

Efficacy is proved

EDITOR,--We are surprised by the negative attitude of Mark Lambert, who suggests that more than 5000 symptomatic patients with stenosis of >70% each year should be denied the benefit of carotid surgery.1 The efficacy of carotid surgery in symptomatic patients with stenosis of >70% has been proved in both European and Northern American trials.2 3 In addition to giving an inadequate and selective review of the literature, Lambert fails to realise the possible difference in the prevalence of the disease between different communities. For example, he mentions that 40% of patients with a transient ischaemic attack are not fit for investigations. He quotes this figure from an article by Hankey et al, who studied 485 consecutive patients with transient ischaemic attacks between 1977 and 1986.4 They did not have non-invasive ultrasonography for screening, and angiography was performed only in patients who were potential candidates for carotid endarterectomy on clinical grounds.

In . . . [Full text of this article]


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Controversies in Management: Should carotid endarterectomy be purchased? Treatment avoids much morbidity
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BMJ 1995 310: 316-317. [Extract] [Full Text]

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