Indications for carotid surgery, angioplasty and stenting and monitoring of microemboli

Carotid endarterectomy (CEA) is proven to be beneficial in symptomatic pati ents with high-grade carotid stenosis (70% to 99%; residual lumen as a perc entage of the normal distal internal carotid artery) on condition that the peri-operative risk for mortality and morbidity is less than 6%. A minority of the "leading experts" in North America (48%) and Western Europe (28%) r ecommends carotid endarterectomy in asymptomatic patients in general. Most experts suggest to perform surgery only in asymptomatic patients who are at risk for carotid occlusion in the near future or embolism. At its present state, angioplasty and stenting is an experimental although promising techn ique which will have to be compared to carotid endarterectomy. Criteria for duplex grading of internal carotid stenosis have been established and syst ematically validated to results of angiography. Pre-surgical use of angiogr aphy will more and more be restricted to selected patients in whom the resu lts of duplex sonography remain inconclusive. The detection of microemboli with transcranial doppler sonography seems to be of particular importance b efore and during carotid angioplasty and stenting.