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MDMC above national average

Monday, April 11, 2005

SIKESTON - Those who need a carotid endarterectomy don't need to look any further than Missouri Delta Medical Center to get one.

MDMC officials won't say they are better than everyone else, "but in this one aspect of medical care, our team here provides a quality of care as good as any center in the country," said Kevin P. Rankin, general/vascular surgeon.

While the hospital has shown a good rate on vascular surgery in general, results were presented last week which show MDMC is performing above the national average for carotid endarterectomies.

"That's where we clean out the artery in the neck that supplies the brain with blood to prevent either recurrent or future strokes," Rankin explained.

While the procedure itself may not sound familiar, it addresses what has been identified as a significant health risk for Americans.

"Stroke is the third leading cause of death in the United States," Rankin said. "Over 150,000 people die each year in the United States of stroke. Another problem is it is the leading cause of disability."

Rankin said 20 percent of strokes are caused by emboli which are the pieces of blood clot and cholesterol plaque which break loose and clog up carotid arteries, preventing blood flow to the brain.

"It's been shown that surgery to clean out the artery is the best treatment for those that have 'mini-strokes,'" Rankin said. A mini-stroke is where the stroke symptoms resolve within 24 hours.

Literature from the North American Symptomatic Carotid Endarterectomy Trial conducted in the U.S. and Canada provided health care officials with a benchmark, according to Rankin.

Those who have a carotid endarterectomy operation have a total complication rate of 5.8 percent. The complication rate adds the mortality rate to the number that have a stroke after having the procedure.

"We recently looked at the experience of doing that operation at Missouri Delta Medical Center," Rankin said. "From 1999 to the present, we found out that our stroke rate was 2 percent and our mortality rate was zero."

"We took all comers," Rankin added, noting that 16 percent were classified as high-risk patients for the procedure, 10 percent being emergency operations and the other 6 percent being re-do's on patients who previously had the operation somewhere else.

Rankin said it took anesthesiology, internal medicine, nursing and surgery staff members working together at their best to achieve these results.

"This is a team effort," he said. "There were many, many people involved in the care of these people."

MDMC performs around 10 to 20 carotid endarterectomies per year, "but we should be doing more," according to Rankin. "Our numbers are less than the Mayo Clinic, Washington University and some of the other larger centers."

Many of those who should have this procedure are undiagnosed while others opt to go elsewhere to have it done.

The NASCET study was scheduled to run for five years but after only two years the results were so conclusive officials stopped testing the medicinal treatments in favor of the surgery, according to Rankin.

Two out of five of the high-risk patients participating in the study who were treated with medications instead of surgery suffered a stroke within two years.