[Indications for treating stenoses of the carotid artery]

The annual stroke risk for patients with asymptomatic stenoses of the carotid artery is around 1% in case of <70% stenosis (NASCET criteria) and 2-5% in patients with >70% stenosis. The risk of recurrent ischemic events for patients with symptomatic stenoses is much higher, around 15% during the first year. For more than 10 years, the efficacy of carotid surgery has been proven, and there is growing evidence to support surgery in case of asymptomatic stenosis. Patients with severe stenoses, male or elderly patients, and those with bilateral stenoses benefit more from surgery. Carotid artery stenting has not proven its safety or efficacy. Despite this lack of evidence, the method is used in many centers as an alternative to surgery. Especially symptomatic carotid artery stenosis should be used mainly in the setting of a randomized trial such as SPACE.