The value of carotid endarterectomy in asymptomatic patients with high-grade carotid stenosis is considered moderate (about a 6% reduction in the absolute risk of stroke or death over five years), and the procedure itself carries a 3% risk of stroke or death. Now a group of researchers has developed an easy-to-use clinical prediction rule to help clinicians calculate the benefits and risks associated with performance of the procedure.

Using hospital charts from 6,553 asymptomatic patients in whom carotid endarterectomy was performed, researchers examined 29 patient and clinical characteristics to assess their potential impact on the risk of stroke or death within 30 days of carotid endarterectomy.

The researchers identified eight factors that were associated with a higher risk of perioperative complications: female sex, nonwhite race, having a distant stroke or transient ischemic attack, the presence of an uncorrected stenosis of 50% or greater, congestive heart failure, coronary artery disease, valvular heart disease, and severe disability. A total risk score was derived from these factors, with one point given for each (with the exception of severe disability, which earned two points). A patient-friendly score excluded the degree of uncorrected stenosis. For either model, a score of 0 to 2 indicated low risk (a rate of death or stroke of 3% or lower), a score of 3 indicated moderate risk (a rate of 4.7%), and a score of 4 or higher indicated a high risk (a rate of 7.5%) of complications.

One of the advantages of the new model, according to the study authors, is that it can be used by patients "to help them make a shared, informed decision about surgery."

Elizabeth G. Mil, an RN and director of Neuroscience Services Operations at Capital Health Regional Medical Center in Trenton, New Jersey, told AJN that when it comes to making decisions about carotid endarterectomy, there are many variables to consider. "I think it is reasonable to consider it for patients between the ages of 40 and 60 with asymptomatic stenosis of 60% to 99%," she said, if the patient is expected to live five years or more "and if the surgical stroke or death risk is less than 3%."-Wayne Kuznar