[Endarterectomy in asymptomatic carotid stenosis: not worth the risk]

A recent trial revealed a reduction in ischaemic infarcts after carotid endarterectomy in patients with asymptomatic carotid stenosis. However, the number needed to treat (NNT) was 22 to prevent 1 stroke in 10 years (including perioperative death as a primary outcome measurement). This is a modest effect in comparison to the trials with symptomatic patients with a 70-99% stenosis (NNT: 6). Furthermore, the number of surgical complications outweighs the benefits of surgery during the first 2 years after treatment. Finally, current medical treatment is significantly more effective than the medical treatment used in the control arm of this trial. Therefore, in our opinion, endarterectomy should not be performed routinely in asymptomatic patients.