[Carotid endarterectomy indicated in asymptomatic stenosis]

Carotid endarterectomy (CE) is of proven value for patients with a high-grade symptomatic stenosis of the internal carotid artery (ICA). Recently, the Asymptomatic Carotid Atherosclerosis Study group showed that in patients with an asymptomatic ICA stenosis of more than 60%, CE caused an absolute risk reduction of perioperative death or stroke during 5 year follow-up of 5.4% (95% confidence interval: 3.0-7.8). Half of these strokes were disabling. The number needed to treat to save one patient from death within 30 days or stroke within in the following 5 years was 19. Further studies are needed to isolate a group of patients that will substantially benefit from the operation. CE is probably most effective in males under 75 years of age. A low surgical morbidity and mortality is an absolute prerequisite to justify CE for an asymptomatic ICA stenosis.