TUESDAY, Sept. 27 (HealthDay News) -- New research suggests that
older patients who undergo surgery to open up clogged arteries in
the neck are more likely to die within a month if their surgeon is
inexperienced, although the risk is still small.
Even so, stenting may still be appropriate for some of these
patients, said study author Dr. Brahmajee K. Nallamothu, an
associate professor of internal medicine at the University of
Michigan Health System.
"The paper is meant more as a wake-up call for ensuring that we deliver this new procedure more optimally by placing it in the hands of operators who have the most familiarity with it," he said.
At issue is a procedure known as carotid stenting, which is
performed on patients whose neck arteries are blocked and are
either at risk for a stroke or mini-stroke, or who have already had
Surgeons guide a catheter placed in the groin up to the neck,
where they prop open an artery using a tube-like device called a
stent. The procedure is complex and requires vascular surgeons to
learn new skills instead of adapting ones that they already have,
In the new study, researchers examined the medical records of
24,701 Medicare recipients, aged 65 and older, who underwent
carotid stenting procedures between 2005 and 2007. Overall, 1.9
percent of patients died within 30 days, but the death rate was
higher -- 2.5 percent -- in those treated by surgeons who performed
fewer than six of the procedures a year. There are a lot of
surgeons with a low level of experience, Nallamothu noted. The
death rate was 1.4 percent among those who performed the most
procedures -- 24 or more a year.
An experience gap remained even after the study authors adjusted
their statistics so they wouldn't be thrown off by factors such as
high or low numbers of patients of certain ages, genders or
Nallamothu said patients should feel comfortable asking their
surgeons about their level of experience. He added that some
research has suggested that surgeons can effectively learn how to
perform cardiac stenting with the help of education programs.
"However," he said, "the extent to which these programs are
routinely used in real-world practice and their overall quality in
such settings is largely unknown."
Stents may not be the best answer for older patients with
clogged neck arteries, especially those over 75, said Dr. John
Francfort, chairman of the department of surgery at Good Samaritan
Hospital Medical Center in West Islip, N.Y.
An alternative surgical procedure known as an endarterectomy to
open up neck arteries may be a better idea, Francfort said.
The study is published in the Sept. 28 issue of the
Journal of the American Medical Association.
For more about the
carotid arteries, visit the U.S. National Library of Medicine.