[Current management of carotid artery stenosis. What does the evidence show us?]

Surgery of carotid artery stenosis as treatment for acute cerebral vascular accident was most used in the 1980s. This surgical procedure is one of the few to have been 'examined' to demonstrate its usefulness by means of a series of prospective multicentric trials, carried out between 1980 and 1990. This paper aims to show the results of these trials and give useful advice for current management of these patients.

We describe the most important studies carried out to date, both in the group of patients with symptomatic and those with asymptomatic carotid artery stenosis. We emphasize the importance of achieving low morbi-mortality, both in the surgical procedure and in diagnosis. We describe the advantages and disadvantages of non-invasive methods of diagnosis, alternatives to cerebral angiography, and discuss current indications for carotid artery surgery in symptomatic and asymptomatic groups.

The most important cooperative studies (ECST and NASCET) have shown the validity of surgical in combination with medical treatment, as opposed to medical treatment alone, in order to avoid further neurological incidents in patients with symptomatic carotid stenosis. The only cooperative study which has shown the superiority of surgical treatment, as compared with medical treatment, in a group of asymptomatic patients was ACAS (particularly in male patients).