Does the neurologist add value to the carotid endarterectomy patient?

作者：Seemant Chaturvedi, Vladimir Hachinski · 发表于：Neurology · 年份：1998 · DOI：10.1212/wnl.50.3.610 · 被引用次数：12 · 研究领域：Cerebrovascular and Carotid Artery Diseases、Cardiovascular Health and Disease Prevention、Intracranial Aneurysms: Treatment and Complications

The efficacy of carotid endarterectomy (CE) in stroke prevention has been evaluated by several randomized clinical trials.1-4 If taken at face value, one could conclude (somewhat paradoxically) that CE is beneficial for symptomatic patients with greater than 70% stenosis and asymptomatic patients with greater than 60% stenosis. The perceived efficacy of CE for both symptomatic and asymptomatic stenosis raises the question Is it necessary to have a patient evaluated by a neurologist at any point on the road to or from the surgeon? If both symptomatic and asymptomatic patients benefit from CE, it would seem that the only necessary elements in the equation for surgical stroke prevention are a patient, an ultrasound machine, a referring physician (who could be a family practitioner or internist), and a surgeon. Should the neurologist be included in this framework? We suggest that neurologists play a critical role in the preoperative, operative, and postoperative evaluation of the CE patient. Preoperative assessment. A central premise of the theme that neurologists can play a major role in the care of the CE patient is the difference in prognosis for patients with symptomatic and asymptomatic carotid stenosis. Considering the annual stroke risk of four commonly encountered clinical conditions (table 1), there is a substantial difference in the likelihood of stroke for symptomatic versus asymptomatic patients. This translates into a significant difference in the risk-to-benefit ...