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The moral of this story appears to be DON'T have a carotid endarterectomy
at the Cleveland Clinic. Of the vascular surgeons I know most would quit doing
the surgery if they had a 12.6% morbidity and mortality risk for there patients since
there is only about a 5% risk of CVA if nothing is done (per year).
Appropos of the topic I just got back from a great Endovascular
Conference held here in Newport Beach, during which there were numerous live
demonstrations of stenting of all types. Of the six carotid stents tried (with a leader in
the endovascular field) two could not be completed and one had a TIA on the table.
Watching them dig around in the arteries trying to get the sheath up took my breath
away. One of the positive aspects of the whole thing was how fast it could be done
when everything went right. No stent for me yet- thank you very much.
Bart Bean

>
>
>
>  Date:   Mon, 25 Nov 2002 07:51:24 -0500
>  From:   "T.D.Case" <[log in to unmask]>
>  Subject:Stent versus endarterectomy
>  To:     [log in to unmask]
>
>
>
>  Colleagues;
>
>
>  A recent study performed at the Cleveland Clinic and released at the
>  American Heart Association meeting in Chicago, reviewed 723 patients
>
>  and compared two groups (endarterectomy and stent placement) for
>
>  perioperative risks which include CVA, MI or death within 30 days of the
>  procedure. The study reports that stents had 5.8% risk compared to that of
>
>  endarterectomy, which had 12.6% risk therefor concluding the superiority of
>
>  stent placement. While the numbers appear impressive, isn't a 12.6% surgical
>  perioperative risk unusually high? It was my understanding that medical
>
>  centers having proficency in vascular surgery had risk closer to the 2% to
>
>  3% area.
>
>  Terry Case

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