[Results of clinical trials evaluating the surgery of carotid stenoses]

The usefulness of carotid endarterectomy remained unsettled until 1991, although it was one of the most widespread surgical interventions. Its indications are now being scientifically established by means of perspective and randomized clinical trials comparing endarterectomy to medical therapy in patients with internal carotid artery atherosclerosis. The results of 2 trials (CASANOVA, VACS#167) performed in asymptomatic patients suggest that there is no evidence that carotid endarterectomy might be of benefit in such patients; however both studies had serious methodological problems that will probably be resolved by a large on-going study (ACAS). The results of 3 trials performed in patients with recent transient ischemic attacks or stroke in the internal carotid artery territory suggest that: (1) carotid endarterectomy is of benefit in patients with a degree of stenosis higher than 70%; (2) carotid endarterectomy is not of benefit in patients with a degree of stenosis smaller than 30%; (3) the best therapeutic strategy remains unsettled in patients with a 30-70% degree of stenosis and in patients examined more than 6 months after neurological deficits.