[Indications for carotid surgery]

The indications for carotid endarterectomy are discussed on the basis of studies of the literature. The most important multicentre studies that have led to these indications are reported and commented on. The recommended strategy with regard to complicating factors such as an occluded contralateral carotid artery, tandem lesions or planned heart surgery is to follow the ordinary indications for surgery. Patients with stroke-in-evolution may benefit from surgery but are difficult to identify. Crescendo transitory ischemic attack should be treated with anticoagulation and immediate operation. Operating on a recurrent carotid stenosis is rarely indicated, and patients needing intervention are perhaps best treated with endovascular techniques.