Outcomes analysis of the treatment of carotid artery disease

Outcomes analysis methodology is becoming increasingly important for documenting the effectiveness of neurosurgical care, including the care of patients with carotid artery disease. Prospective randomized trials of carotid endarterectomy in symptomatic and asymptomatic patients with carotid artery stenosis have demonstrated the efficacy of this procedure for stroke prevention. The benefit of surgery accrues only if the surgery can be done with acceptably low perioperative morbidity and mortality rates, however, and it is not clear that the data reported in prospective randomized studies accurately reflect the present practice of carotid endarterectomy. The introduction of endovascular treatment of carotid artery stenosis introduces another layer of complexity when trying to determine the best course of treatment for patients with carotid artery stenosis. Such treatment must be included in determining the effectiveness of care for patients with carotid artery disease. Individual practitioners caring for patients with carotid artery stenosis need to continuously monitor their practice to document complication rates, functional outcomes, and lesional outcomes following surgical and endovascular treatment. Outcomes studies presently underway may help to clarify which patients are most likely to benefit from which treatment in an individual practice.