[Surgery for a recently symptomatic severe carotid stenosis, indicated or not? Clinical application of...

Two trials have shown that carotid surgery reduced the risk of stroke or death for patients with a recently symptomatic severe carotid stenosis. Nevertheless, it remains difficult to advise in individual cases. The risk of a stroke is about 20% in the next 3 years on medical treatment alone. This means that surgery is of no value in about 80% of the patients. With the help of prediction rules (developed by Rothwell and Warlow) it is possible to further individualize the decision whether or not to operate, by incorporating factors such as the angiographic roughness of the stenosis lining, the time since the cerebrovascular symptoms appeared, the extent of the stenosis, increased operation risk, sex, peripheral vascular disease and systolic blood pressure. If these prediction rules prove to be correct, doctors will be able to better advise their individual patients.