Carotid endarterectomy for stroke prevention revisited

Since its original description, more than 50 years ago, carotid endarterectomy (CEA) has been challenged in its success in achieving adequate stroke prevention among both symptomatic and asymptomatic patients with cervical carotid stenosis. CEA remains the most common vascular surgical operation performed today, however, its future has been called into question with the introduction of percutaneous carotid angioplasty and stenting, more effective antiplatelet agents (i.e., clopidogrel), cholesterol-lowering agents (i.e., statins) and angiotensin-converting enzyme inhibitors. The focus of this article is to review the notable trials substantiating the efficacy of CEA, indications for surgery and technical components that have refined expected favorable outcomes.