Carotid stenosis and carotid endarterectomy

This review focuses on the natural history of symptomatic and asymptomatic carotid stenosis and on the risk/benefit ratio of carotid endarterectomy. Five randomized trials for symptomatic stenosis and four trials for asymptomatic carotid occlusive disease are reviewed. Carotid endarterectomy has been proved effective in reducing stroke risk in symptomatic 70-99% stenosis. Conclusive results are still pending for moderate symptomatic stenosis and the asymptomatic lesion. Surgical controversies and techniques are discussed. Algorithms for management of symptomatic and asymptomatic stenosis are offered.