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Attitudes of Canadian and U.S. Neurologists Regarding Carotid Endarterectomy for Asymptomatic Stenosis

Published online by Cambridge University Press:  04 August 2016

Seemant Chaturvedi ,
Jody L. Meinke ,
Ellen Pierre  and
Bryan Bertasio
Seemant Chaturvedi*
Affiliation:
Department of Neurology, Wayne State University/Detroit Medical Center
Jody L. Meinke
Affiliation:
Center for Healthcare Effectiveness Research, Wayne State University/Detroit Medical Center, Detroit, MI, USA
Ellen Pierre
Affiliation:
Department of Neurology, Wayne State University/Detroit Medical Center
Bryan Bertasio
Affiliation:
Department of Neurology, Wayne State University/Detroit Medical Center
*
Dept. of Neurology, Wayne State University, 8C-UHC, 4201 St., Antoine, Detroit, MI 48201, USA.
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Abstract:

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Background:

The American Heart Association carotid endarterectomy (CE) guidelines endorse CE for asymptomatic carotid stenosis if the procedure can be performed with low morbidity. However, the Canadian Stroke Consortium has published a consensus against CE for asymptomatic stenosis. The views of practicing neurologists in the two countries on this subject are unclear.

Methods:

A survey was undertaken of 270 neurologists from either Florida or Indiana and 180 neurologists from either Ontario or Quebec.

Results:

The survey was returned by 36% of neurologists. Both Florida (65%) and Indiana neurologists (35%) were significantly more likely than Canadian neurologists (11%) to sometimes/often refer patients for surgery(p<0.001). Neurologists from Florida relied more on noninvasive methods of carotid stenosis assessment (36%) than Canadian neurologists (12%, p=0.003), who preferred angiography. Neurologists from Florida more often cited medicolegal concerns as a reason for referring patients for surgery (27%), compared to Canadian neurologists (3%, p=0.0001).

Conclusions:

Practices pertaining to carotid stenosis evaluation and management differ both regionally and by country. Canadian neurologists refer fewer asymptomatic patients for CE and rely more on angiography as a preoperative diagnostic tool. The potential of medicolegal liability is a greater force in clinical decision-making for certain U.S. neurologists, compared to their Canadian counterparts. These differences may partly explain the variations in CE utilization in the two countries.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue 2 , May 2000 , pp. 116 - 119
Copyright
Copyright © The Canadian Journal of Neurological 2000

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