Attitudes of Canadian and US neurologists regarding carotid endarterectomyfor asymptomatic stenosis

Background: The American Heart Association carotid endarterectomy (CE) guid elines endorse CE for asymptomatic carotid stenosis if the procedure can be performed with low morbidity. However, the Canadian Stroke Consortium has published a consensus against CE for asymptomatic stenosis. The views of pr acticing: neurologists in the two countries on this subject are unclear. Me thods: A survey was undertaken of 270 neurologists from either Florida or I ndiana and 180 neurologists from either Ontario or Quebec. Results: The sur vey was returned by 36% of neurologists. Both Florida (65%) and Indiana neu rologists (35%) were significantly more likely than Canadian neurologists ( 11%) to sometimes/often refer patients for surgery (p<0,001), Neurologists from Florida relied more on noninvasive methods of carotid stenosis assessm ent (36%) than Canadian neurologists (12%, p=0.003), who preferred angiogra phy. Neurologists from Florida more often cited medicolegal concerns as a r eason for referring patients for surgery (27%), compared to Canadian neurol ogists (3%, p=0.0001). Conclusions: Practices pertaining to carotid stenosi s evaluation and management differ both regionally and by country. Canadian neurologists refer fewer asymptomatic patients for CE and rely more on ang iography as a preoperative diagnostic tool. The potential of medicolegal li ability is a greater force in clinical decision-making for certain U.S neur ologists, compared to their Canadian counterparts. These differences may pa rtly explain the variations in CE utilization in the two countries.