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We found a high level of interrater agreement for all guidelines using multiple statistical measures.Members agreed that evidence e is insufficient to endorse carotid endarterectomy for asymptomatic patients with angiographically proven stenosis of more than 60%(k=0.70,P<.01). Reasons cited included concern over the reproducibility of low surgical morbidity rates in the community at large,the questionable clinical benefit conferred by surgery,and the lack of proven reduction in the risk of major disabling stroke.Screening the general population for asymptomatic stenosis was unanimously rejected.Also,screening even patients with risk factors or proven atherosclerosis at other sites was not endorsed(k=0.91 and k=0.79,respectively,both P,.01).There is insufficient evidence to recommend carotid endarterectomy for asymptomatic patients.Evidence is also insufficient to endorse a screening strategy even for patients with risk factors for carotid disease.While stroke prevention remains a critical goal,we do not recommend that it be accomplished by screening or by performing carotid surgery in asymptomatic patients. |
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