[Asymptomatic carotid artery stenosis: when should one--when must one--when should one not operate]

More differentiation than in the past is necessary for the indication of surgery in asymptomatic carotid stenosis. Surgery is indicated in the case of high-degree stenosis (above 80%) before major surgery, rapidly increasing stenosis--especially filiform stenosis--and if non-characteristic complaints are associated with cerebrovascular insufficiency or suspicious CT. Symptomatic carotid stenosis, however, requires surgical treatment. Unilateral asymptomatic stenosis below 70% requires careful observation and no surgery, particularly if the patient is older than 70 years. Surgical experience as well as collaboration with other disciplines are basic requirements.