The Appropriateness of Carotid Endarterectomy

To the Editor.—  The growth in frequency of carotid endarterectomies in the United States during the 1970s and through 1984 has been documented by Dyken and Pokras.¹ Updated information from Veterans Administration (VA) medical centers shows that the number of carotid endarterectomies was stable from 1983 (fiscal year, starting Oct 1, 1982) through 1985, after growing at about 12% a year (compounded) for three years, or a total of about 50%, from 1980 to 1983 (Figure). In 1984 the number of procedures fell 0.2% (seven procedures) and in 1985 rose 2.2% (68 procedures).Carotid endarterectomies were done in 117 VA medical centers (172 institutions total); the 102 VA medical centers affiliated with academic medical centers performed 96% of the carotid endarterectomies. Recent professional concern^2-4 about complications and benefits of carotid endarterectomies could have already influenced medical decision making sufficiently to curtail the frequency of carotid endarterectomies in VA