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I read with interest the article by Durward et al¹ on the technically successful carotid endarterectomy procedures that they performed on the elderly. No doubt the group has considerable experience given the fact that they have operated on many patients, several of whom were over the age of 89. Based on their still limited experience in this specific subgroup, the authors claim that an operation should be considered for symptomatic patients in good clinical condition. It appears that this conclusion may need some tempering. In the accompanying critique, Mayer² states that many surgeons may remain reluctant because of the high likelihood of comorbid conditions being present and also notes that one can only do so much with scarce health care resources. A simple cost-effectiveness analysis will show that because of the quite limited life expectancy, very little health may be gained in this subcategory of patients, whereas expenditures will be . . . [Full Text of this Article]

AUTHOR INFORMATION
Erik Buskens, MD, PhD

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