Thanks Bill for the thoughtful response. Since I work at the Cleveland Clinic Foundation I was taken aback by some of those responses.
I just gave a talk at our local vascular group (NOVA) explaining the reasoning behind carotid stents and have some intriguing statistics on carotid endarterectomy. Remember that the NASCET and ACAS trials set the standards for CEA. These guidlines were made by the American Heart Association for a certain subset of pts. Those with a 3-10% risk. That my friends are where the low percentage of postop complications and death come in. There are a subset of pts. we see in our labs that are considered higher risk for stroke and perioperative complications > than 10%. These pts. carry certain co-morbidities or anatomical conditions. There are several documented studies that define pts. at high risk and they need alternative therapy. There are well documented retospective reviews showed the subets of pts. with % of 10 to 40.
To make a long story short the patients used in the study that was presented @ AHA are high risk pts. with radiated necks, previous CEA (sometimes twice), severe heart disease, renal failure, ect. Those patients have documented well over the AHA recommended percentage. Lastly, there were 30 site in this study, the surgeons did at least 30 CEA's per year and had a complication rate of 3% or less by their self reporting, the single largest surgical site was CCF.
For further info on this topic go to this web site: www.theheart.org/lite.cfm?DGFDEED. Also watch on NBC Nighty news this weekend to see and here Dr. Jay Yadav CCF doing an actual case.
Well I hope I have helped people understand this information that was given. Feel free to contact us at the Cleveland Clinic Foundation for any questions. We have a web site that can put you in touch with anyone.
Have a safe and happy thanksgiving.
Paula Gehr RVT
Senoir Research Vasc. Tech.
Cleveland Clinic Foundation
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