About half of the 100,000 operations performed annually on Americans to remove blockages from arteries supplying blood to the brain are of doubtful value, experts say.
More than $2 billion is spent annually on the operation, called an endarterectomy.But the benefit of the procedure remains unproven for one of every two people who undergo it, said Dr. Murray Goldstein of the National Institute of Neurological Disorders and Stroke.
Studies have shown that endarterectomy can be a lifesaver for patients with severely blocked arteries, but it is not certain that the operation is appropriate for many other patients, Goldstein said Tuesday at a meeting of the International Stroke Society.
Endarterectomy is a surgical procedure in which blockages are removed from the carotid arteries, the major blood vessels supplying blood to the brain. The procedure was developed as a way to possibly prevent strokes that result when the carotids become totally blocked and blood flow to the brain is cut off.
The surgery enjoyed a boom in popularity in the early 1980s, but later doctors began to question if the procedure really prevented strokes and it became less common.
Last year, a study sponsored by the institute showed that endarterectomy can reduce the risk of stroke by 17 percent or more in patients with carotid blockages of 70 percent to 99 percent and with strokelike symptoms.
There was no benefit shown for patients with 29 percent or less blockage or for patients without symptoms.
For patients with 29 percent to 70 percent blockages - the wide middle range of disease - there have been no studies showing that endarterectomy has any proven value.