Decision analysis and carotid endarterectomy

Abstract

A data base and a framework for clinical decision analysis are provided to enable the clinician to determine the value of carotid endarterectomy in patients with transient ischemic attacks. This approach permits optimal utilization of available data, maximizes the value of informed consent by clearly delineating areas of physician and patient expertise, and permits a quantitative assessment of the impact of uncertainty regarding underlying variables on decision outcome. The results of the analysis indicate that (a) the late nonstroke death rate has little effect on the value of endarterectomy, (b) the patient's relative valuation of stroke and immediate versus delayed death are among the most crucial variables underlying the value of endarterectomy, and (c) endarterectomy may be indicated in certain patients with transient ischemic attacks, but when its utility is measured in terms of value rendered to the patient, its relative cost may be greater than that of certain life-saving operations such as heart or liver transplant.