[Carotid endarterectomy. A justifiable risk for the prevention of ischemic infarct?]

Defining the position of carotid endarteriectomy (CEA) is difficult, since the average mortality and morbidity risk of this procedure--an estimated 10% or so overall in the USA--is apparently much higher than is achievable in highly specialized centers or is indicated by uncontrolled studies. No clear indication is recognizable for asymptomatic stenoses. Possible exceptions are rapidly progressing and high-grade stenoses. Prophylactic CEA within the framework of major surgical interventions increases the risk of perioperative stroke. In the event of transient ischemic attacks (TIA), carotid endarteriectomy is justifiable when cardiac sources of embolism, severe intracranial vascular stenoses and a predominantly cerebral microangiopathy have all been excluded, as also internistic and neurological disorders that increase the risks of surgery. In the acute insult stage, CEA increases mortality severalfold, and is therefore contraindicated.