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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.
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References
- Clinical decision analysis. Saunders, Philadelphia1980
- Changing patterns in the practice of carotid endarterectomy in a large metropolitan area.JAMA. 1986; 255: 2609-2612
- Cerebral angiographic risk in mild cerebrovascular disease.Stroke. 1990; 21: 209-222
- A comparison of risk factors and prognosis for transient ischemic attacks and minor ischemic strokes.Stroke. 1989; 20: 1494-1499
- Transient ischemic attacks in a community.JAMA. 1969; 210: 1428-1434
- Epidemiology of cerebrovascular disease.in: Ross-Russel RW Vascular disease of the central nervous system. Churchill Livingstone, New York1983: 1-24
- Clinical features and long term follow-up of patients with reversible ischemic attacks (RIA).Acta Neurol Scand. 1978; 57: 471-480
- The natural history of transient ischemic cerebrovascular attacks.Quart J Med. 1954; 33: 309-324
- Transient ischemic attacks. Retrospective study of 150 cases of ischemic infarct in the territory of the middle cerebral artery.Stroke. 1979; 10: 259-262
- Prognosis in patients with transient ischemic attacks.Stroke. 1973; 4: 666-673
- Carotid and vertebral basilar transient cerebral ischemic attacks. A community study, Rochester, Minnesota.Mayo Clin Proc. 1977; 52: 117-120
- Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med. 1991; 325: 445-453
- MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis.Lancet. 1991; 337: 1235-1243
- Prognostic implications of retinal versus hemispheric TIA in patients with high grade carotid stenosis: observations from NASCET.Stroke. 1992; 23: 159
- Late results after carotid endarterectomy for amaurosis.J Vase Surg. 1987; 6: 333-340
- Immediate and long term results of carotid endarterectomy.Stroke. 1989; 20: 1138-1142
- Cumulative stroke and survival ten years after carotid endarterectomy.J Vasc Surg. 1985; 2: 661-668
- Carotid endarterectomy in patients with territorial transient ischemic attacks.J Vasc Surg. 1988; 8: 447-452
- Long-term prognosis after carotid endarterectomy.Eur Neurol. 1986; 25: 36-39
- Carotid artery surgery in patients with minor stroke.Br J Surg. 1983; 70: 13-16
- Carotid endarterectomy for unilateral carotid system transient cerebral ischemia.Mayo Clin Proc. 1983; 58: 171-175
- Cerebral arterial insufficiency: one to 11-year results following arterial reconstruction operation.Ann Surg. 1965; 161: 921-945
- Results of carotid endarterectomies for transient ischemic attacks-five years later.Ann Surg. 1973; 178: 258-264
- Joint study of extracranial arterial occlusion. IX Transient ischemic attacks in the carotid territory.JAMA. 1976; 235: 2608-2610
- Late survival after carotid endarterectomy for transient ischemic attacks.J Vasc Surg. 1984; 1: 512-519
- Carotid endarterectomy.Arch Surg. 1981; 116: 1569-1573
- Natural history of stroke in Rochester, Minnesota, 1955 through 1969: an extension of a previous study, 1945 through 1954.Stroke. 1973; 4: 20-29
- Life-table analysis of survival after cerebral thrombosis-ten-year experience.JAMA. 1959; 169: 1149-1152
- Survival and recurrence following stroke. The Framing-ham Study.Stroke. 1982; 13: 290-295
- The natural history of hemispheric and brainstem infarction in Rochester, Minnesota.Stroke. 1984; 15: 790-794
- Whose utilities for decision analysis.Med Decis Making. 1990; 10: 58-67
- Measurement of individual preferences. The importance of “situation-specific” variables.Med Decis Making. 1982; 2: 483-495
- Asymptomatic carotid stenosis.Stroke. 1985; 16: 900-901
- The Markov process in medical prognosis.Med Decis Making. 1983; 3: 419-458
- Utility functions for life years and health status.Oper Res. 1980; 28: 206-224
- Why saying no to patients in the United States is so hard: cost containment, justice and provider autonomy.N Engl J Med. 1986; 314: 1380-1383
- The painful prescription: a procrusteanperspective.N Engl J Med. 1986; 314: 1383-1386
- One miracle, many doubts. Time Dec. 10. 124. 1984: 70-77
- Carotid endarterectomy studies: a glimmering of science.Stroke. 1986; 17: 355-358
- Improved results of carotid endarterectomy in patients with symptomatic coronary disease: an analysis of 1,546 consecutive endarterectomies.Stroke. 1979; 10: 122-125
- Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy.Mayo Clin Proc. 1981; 56: 533-543
- Multifactorial index of cardiac risk in noncardiac surgical procedures.N Engl J Med. 1977; 297: 845-850
- Ontheelici-tation of preferences for alternative therapies.N Engl J Med. 1982; 306: 1259-1262
- Fallacy of the five-year survival in lung cancer.N Engl J Med. 1978; 299: 1397-1401
- Asymptomatic tight stenosis of the internal carotid artery: long-term prognosis.Neurology. 1986; 36: 861-863
- Natural history of nonstenotic asymptomatic ulcerative lesions of the carotid artery.Arch Surg. 1982; 117: 1493-1497
- Natural history of asymptomatic extracranial arterial disease. Results of a long-term prospective study.Brain. 1987; 110: 777-791
- Surgical versus nonoperative treatment of asymptomatic carotid stenosis.Ann Surg. 1986; 204: 163-171
- Noninvasive assessment of stroke risk in asymptomatic and nonhemispheric patients with suspected carotid disease.Ann Surg. 1985; 202: 491-504
- Vascular risks of asymptomatic carotid stenosis.Stroke. 1991; 22: 1485-1490
- Stroke rates in patients with lacunar and large vessel brain infarctions.J Neurol Sci. 1993; 114: 128-137
- Risk factors in a community experience with carotid endarterectomy.J Vasc Surg. 1989; 10: 178-186
- Life expectancy and late stroke following carotid endarterectomy.Ann Surg. 1983; 198: 80-86
- Arrogance.N Engl J Med. 1980; 303: 1507-1511
- Preferences for health outcomes. Comparison of assessment methods.Med Decis Making. 1984; 4: 315-329
- Discount functions and the measurement of patients' values. Women's decisions during childbirth.Med Decis Making. 1984; 4: 47-58
- Endarterectomy in carotid artery disease. A decision analysis.JAMA. 1987; 258: 793-798
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© 1993 Published by Elsevier Inc.
