The current status of carotid artery surgery

The natural history of extracranial cerebrovascular disease and available alternatives in its treatment are reviewed. An evaluation of the evidence suggests that carotid endarterectomy is the treatment of choice in patients with transient ischemic deficits, provided that an anatomically appropriate lesion can be identified. These patients have a 25-38% chance of stroke if untreated, which can be reduced to 5-10% by carotid endarterectomy. Patients with asymptomatic carotid stenosis who are good operative risks are also candidates for surgery, although this issue remains controversial. Patients with small asymptomatic ulcerated carotid plaques have a relatively benign prognosis and should not undergo preventive carotid surgery. Carotid surgery is occasionally indicated in patients with vertebral basilar insufficiency and carotid stenoses, fibromuscular dysplasia, or carotid kinks associated with symptoms of ischemia. Carotid endarterectomy may be performed with an overall mortality of 1-2% and morbidity of 2-5% if the patients are carefully selected and the surgical team is expert.