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David Matchar, MD
Duke University Medical Center Durham Veterans Administration Medical Center Durham, NC

Stephen G. Pauker, MD
New England Medical Center Hospital Tufts University School of Medicine Boston

JAMA. 1987;258(24):3514.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

Although Dr Rolak believes that carotid surgery has no efficacy in preventing cerebral ischemic events, not all of his colleagues would agree. Many physicians believe that the procedure can be useful, even lifesaving, in certain patients or subsets of patients. They might argue that the overall series reported in the literature can mask the benefit in specific patients. The model we developed attempts to focus this debate by replacing emotional tirades by measured logic. Through sensitivity analysis, we asked under what circumstances would carotid endarterectomy offer any benefit, and what would the magnitude of that benefit be. We identified three factors that are central to this judgment: (1) the rate of operative complications, (2) the rate of ischemic events without surgery, and (3) the efficacy of surgery in the specific clinical circumstance.

By focusing on these variables, we hoped to enhance the quality of the scientific debate and . . . [Full Text PDF of this Article]

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