1. Hospital mortality rate on average is 20% higher in non-trial hospitals. 60% of hospitals perform fewer than 17 CEA per year. 88% of surgeons perform at or below median value of 21 CEA per year. Stroke morbidity is 7.7% in hospitals performing CEA at numbers in the lowest quartile vs 2.5% for the highest quartile (p< 0.03). CEA results are clearly better in high volume institutions / surgeons.

4. Carotid Endarterectomy 1971 to 1999 (Rates per Thousand) 1971 -- 15,000 CEA performed in U.S. 1974-1985 - CEA most common vascular operation > 1 million worldwide. 1986 and 1988 - Rand data - “substantially overused” 1988-present - complex, randomized, multi-center controlled clinical efficacy trials

5. 1954 -- First carotid reconstruction for stroke prevention 1955 -- First CEA using techniques similar to 1999. 1971 -- 15,000 CEA performed in U.S. 1974-1985 - CEA became firmly established as the most common peripheral vascular operation with over 1 million performed worldwide. 1986 and 1988 - Rand Corp data - CEA “substantially overused”

6. Carotid Endarterectomy 1971 to 1998 (Rates per Thousand) Year

7. CEA Cases/Quarter/100,000 State of Florida 1992-1996 ACAS Advisory

8. Florida CEA Procedures as Percent of 1992-Q1 Adjusted for Age

9. 1988-present -- an unprecedented series of complex, randomized, multi-center controlled clinical efficacy trials have been initiated and completed. NASCET (1991, 1998) ECST (1991, 1996) VA Cooperative Studies Program (1991) CASANOVA (1991) VA Cooperative Study Group (1993) ACAS (1995) ACST (ongoing)

10. Trials for symptomatic and asymptomatic stenosis %