Carotid endarterectomy: does it work?

IF CAROTID ENDARTERECTOMY WAS A DRUG its efficacy would require scrutiny and licensure by the Committee on Safety of Medicines in the United Kingdom and by the Food and Drug Administration in the United States. Surgical procedures, unlike drugs, are exempt from the requirement that the risks of treatment be shown to be unequivocally less than the risks of notreatment. That carotid endarterectomy can and does cause stroke and death is not in doubt and the main issue is whether this risk is greater or less than that of restricting therapy to medical treatment. While thousands of patients having the operation have been reported in the literature, and it is said to be "the most commonly performed vascular operation, 1 and "one of the most commonly performed operations" in the United States, 2 ony one inconclusive randomised trial has been published.*