The appropriateness of carotid endarterectomy.

To the Editor.— The recent article entitled "Use of Carotid Endarterectomy in Five California Veterans Administration Medical Centers" by Merrick et al 1 concluded that carotid endarterectomy is overutilized within some segments of the Veterans Administration patient population. This conclusion was obtained following a retrospective review of the records of 95 patients in five Veterans Administration hospitals who underwent 107 carotid endarterectomies for a variety of indications in 1981. The appropriateness or inappropriateness of such intervention was determined by the application of the Rand/ UCLA Health Services Utilization Study (HSUS) on indications for carotid endarterectomy. The authors' intent was to determine whether this high-cost procedure was being utilized appropriately or overutilized. In this context, indications for carotid endarterectomies performed were found to be appropriate in 55% of patients, equivocal in 32%, and inappropriate in 13%. Although the authors' intention was worthwhile, the conclusions reached by Merrick and colleagues are suspect