BENEFIT - RISK-EVALUATION OF ENDARTERECTO MY FOR ASYMPTOMATIC CAROTIDSTENOSIS

In this review we draw a conclusion on the benefit and risks of the op eration of asymptomatic stenotic leasons of the carotid artery referin g to different pro- and retrospective studies. Long-term follow up obs ervations on high grade carotid stenosis (> 80%) revealed an incidence of ipsilateral strokes of 2.5% per year [38], whereas after operation the incidence has been reduced to 0.2-0.5% per year [20]. The charact eristics, the clinical significance of stenotic carotid leasons and th e diagnostical features are summarized. Nowadays a perioperative morta lity rate of 1.1% and morbidity rate (stroke) of 1.6% can be expected in experienced vascular surgical departments. Even advocates of non-op erative treatment, who demanded a combined perioperative mortality and morbidity rate below 3% perceive that a prognostical benefit has been achieved within the first year after the operation. We therefore reco mmend the prophylactic operation for patients with asymptomatic high g rade (> 80%) carotid stenosis, in ulcerative and smooth plaques, in st enosis of the contralateral side and prior or simultaneous with bypass operation, whenever there is a high expectation of life and low anaes thetic risk.