[Should asymptomatic carotid stenosis be operated on?]

Should asymptomatic carotid stenosis be operated on? The aim of the present editorial is to stress that there is no simple answer to this question. The only undisputed point is that mild non hemodynamic stenosis carry such a low risk of ipsilateral brain infarct that surgery is unjustified. For tight asymptomatic stenosis ( > or = 75% at angiography according to the European method of measurement, > or = 60% according to the American method), the indication of surgery should be discussed on a case by case basis. Four main factors should be taken into account: the spontaneous risk of ipsilateral brain infarct (2% per year for stenosis > or = 75%) the risk of surgery (which should be less than 3%); the patient's life expectancy, and his own will as regards a surgical operation. It is thus possible to evaluate for each patient, the pertinence of preventive surgery and the benefit/risk ratio of the operation in order to optimize the surgical decision.