(An epidemiological needs assessment of carotid endarterectomy in an English health region. Is the need being met?)
Strong evidence exists that carotid endarterectomy (an operation on the carotid artery) is an effective intervention for the prevention of stroke in patients with symptoms of obstructions in the carotid area. A paper in this week's BMJ shows that in one English region only half the people in need of the treatment actually get it.
Stroke is the third commonest cause of death in the UK and the commonest cause of physical disability. Ferris et al looked at all patients in the former Wessex Regional Health Authority who had had the carotid artery reconstruction and compared this with the estimated level of need in patients with related symptoms. They noted that while the operation rate more than doubled in the early 1990s after national guidelines were produced, there was still a large unmet need. By 1995-6 the operation rate was 89 per million, but the need was estimated at 153 per million of the population who had symptoms such as a transient heart attack or minor stroke.
Dr P Roderick, Senior Lecturer, Wessex Institute for Health Research and Development, University of Southampton, Southampton General Hospital