[Endarterectomy and carotid angioplasty: surgical perspective]

Carotid endarterectomy (CE) is a well-established operation, although recently it has been challenged by newer, less invasive procedures such as carotid angioplasty with or without insertion of a stent.

In this article the author gives his views on the use of CE in patients with carotid stenosis, both those with and those without symptoms, and also those in whom no definite indication has yet been established. In symptomatic carotid stenosis it had been clearly shown that CE is an effective procedure for the prevention of strokes and death from strokes in patients with carotid stenosis of over 70%, provided that the patients have reasonable general health and life expectation. There is only minor benefit from surgery in patients with asymptomatic disease of the carotid arteries and much less than in those with symptomatic carotid disease. Therefore endarterectomy is recommended when there is obvious progression of the degree of stenosis, especially when the stenosis has reached 70% or the patient begins to complain of symptoms. One of the most serious complications of CE is acute myocardial infarction.

It is a good time to design careful randomised studies to compare endarterectomy with angioplasty, probably with stenting, in a selected group of patients at greater risk than those accepted for endarterectomy.