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Controversies in Neurology |

Carotid Endarterectomy for Asymptomatic Stenosis

Vladimir Hachinski, MD, FRCPC, DSc
Arch Neurol. 1999;56(7):881. doi:10.1001/archneur.56.7.881.
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PREVENTION is infinitely more effective than treatment, hence the appeal of striking before disease does. Castaldo argues that in asymptomatic patients selected carefully according to criteria encompassed in his C-A-R-O-T-I-D mnemonics, endarterectomy can be of benefit. Chaturvedi counters by pointing out that the absolute risk reduction in ipsilateral stroke rate was only 1.5% between the treatment and control groups. Sixty-seven patients need to be operated on to prevent 1 stroke. He questions whether spending $1.5 million to prevent 1 nondisabling stroke can be justified.

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