Carotid endarterectomy - Which patients can benefit?

Carotid endarterectomy is not a treatment for stroke or TIA but is performe d only to reduce the risk of stroke. When a patient has a TIA or nondisabli ng stroke and is found to have carotid stenosis of 50% or greater on the si de corresponding to the ocular or cerebral event, carotid endarterectomy af fords an appropriate significant opportunity to prevent a subsequent stroke . Carotid endarterectomy for patients with severe but asymptomatic disease ca n also provide an opportunity to reduce the risk of stroke. However, since the risk-benefit ratio is much smaller in these cases, the comorbid conditi ons and patient preferences need to be factored into the decision making. F or both symptomatic and asymptomatic carotid artery stenosis, the surgeon s hould be experienced in performing carotid endarterectomy and should have s urgical outcomes similar to those of the surgeons who participated in the c arotid endarterectomy trials. Carotid angioplasty with or without stenting is still being evaluated in cl inical trials to determine its role in reducing the risk of stroke in patie nts with carotid artery stenosis.