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A Journal on Forensic Medicine
Minerva Medicolegale 2000 June;120(2): 79-92
Carotid stenosis. Clinical aspects, surgical methods and medico-legal problems
Extra-cerebral vascular diseases are responsible for 70% of ischemic strokes, third cause of death in the world-wide statistics. Endarterectomy has been found to be a useful therapeutic means in symptomatic patients in order to prevent death and disability, due to carotid atherosclerosis. The North American Study , NASCET, and the European Study, ECST, have achieved these results. These two trials pointed out very important guidelines on the therapeutic behavior and efficiency of endarterectomy in patients with carotid stenosis. Jurisprudential doctrine requires the specialist physician to effect medical assistance in conformity with the general average knowledge of specialist doctors, dedicated to chose the best therapy for the patient, keeping in mind his physiopathologic integrity, in full respect of his legal sphere. NASCET and ECST represent the standard and scientific quality level, but are, from the medico-legal point of view, a double-edged weapon, since they are not always applicable to single patients and it is absolutely not true that they prevent the vascular surgeon from the accusation of malpractice. Every time he will go beyond them he will be obliged to carefully explain the reason on the informed consent, while dogmatic use may lead him to penal procedures for negligence and/or imprudence.