If your doctor says your carotid arteries require stenting, you MUST get a second opinion

Steady as she goes

Some numbers can make your head spin, so you might want to brace yourself for this one…

Nearly $2.5 trillion is spent on health care in the U.S. every year.

That’s a dizzying amount, but here’s the real brain spinner: A huge percentage of that total (about $750 billion) is devoted to procedures or drugs that patients don’t even need.

One of the most blatant examples of this unnecessary “care” is the treating of carotid arteries that are partially blocked by plaque.

If your doctor says you need to go under the knife to clear your carotid arteries, I have some numbers for you that might help keep your head steady and prepared to make the right decision.

Surgeons gone wild

The carotid arteries are two large blood vessels on either side of your neck. They deliver blood to your head and brain, so a significant narrowing of either artery raises your risk of stroke.

In the 1950s, surgeons began removing carotid blockages with a technique called carotid endarterectomy. In this risky procedure, the artery is opened, plaque buildup is dragged out, and the artery is closed. About three percent of patients experience a stroke or heart attack during surgery.

Clinical trials have shown that endarterectomy reduces risk of stroke by only 1 to 5 percent over five years. So, given the dangerous nature of the surgery, it’s only recommended for people at highest risk of stroke.

Well…that’s the ideal. The practice is quite a bit different.

Oxford neurologist and stroke researcher Peter Rothwell told Discover magazine that his research reveals a situation you might call Surgeons Gone Wild.

Rothwell reports that 80 percent of endarterectomies are performed on low-risk patients who don’t even have symptoms linked to blocked carotid arteries. Only two in 10 are appropriate candidates for the procedure!

In recent years, surgeons have been using a less invasive stenting technique that opens carotid arteries with mesh tubes. This would seem to be safer than actually cutting the veins open, but a 2006 study of the procedure was stopped when death rates soared higher than expected.

In 2010, another study found that within four years after surgery, more deaths were reported among those who received stents than among endarterectomy patients.

In spite of these obvious dangers, Businesswire estimates that the world market for carotid stenting will be valued at $300 million by 2015 — a 100 percent increase over the 2010 value.

Don’t let yourself get caught up in this stenting marketing drive. If your doctor recommends either of these invasive procedures to address blocked carotid arteries, and if you’re not absolutely certain you’re a genuine high-risk candidate, seek out a reliable second opinion.

And don’t worry about the Stenters Gone Wild. You can be sure they’ll reach the $300 million mark and beyond within the next three years without you.

“The Problem With Medicine: We Don’t Know If Most of It Works” Jeanne Lenzer and Shannon Brownlee, Discover magazine, Published online 2/11/11, discovermagazine.com
“Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis” New England Journal of Medicine, Vol. 355, 10/19/06, nejm.org