Roto-Rooter: Reassessing stroke surgery

This year alone, more than 100,000 Americans will undergo carotid endarterectomy, a Roto-Rooter-like procedure designed to scoop fatty blockages from the carotid artery in the neck. The operation is intended to reduce the chance of stroke by allowing blood to flow more freely through the carotid to the brain. There is just one problem, bluntly stated last week at an American Heart Association meeting by Dr. Mark Dyken, chief of neurology at Indiana University: "No careful study has ever shown any conclusive benefit." Of more concern, according to a survey conducted by Dyken and Statistician Robert Pokras, the operation carries a 2.8% risk of death and at least as great a risk of actually causing a stroke. "In the light of present knowledge," said Dyken, "there are too many procedures, performed by too many surgeons, in too many places, with too high stroke-and-death rate."

Responding to Dyken, Neurosurgeon James T. Robertson of the University of Tennessee agreed that the excess surgery is "indefensible." Other surgeons are not so quick to condemn current practice. Since thorough studies have not been conducted, says Dr. Russel Patterson, president of the American Association of Neurological Surgeons, "nobody knows whether the operation is overdone."

Several controlled studies of the merits of endarterectomy are in the planning stages. But for now, doctors suggest, candidates for such surgery should get a second opinion. Then if they decide to go ahead, they should choose an experienced surgeon at a major medical center.