What are the evidence-based indications for carotid endarterectomy and perioperative aspirin use in patients with carotid stenosis?
This review summarizes evidence-based recommendations for carotid endarterectomy, highlighting its benefit in severe symptomatic stenosis and the importance of perioperative low-dose aspirin.
Evidence supports carotid endarterectomy for severe (70 to 99%) symptomatic stenosis (Level A). Endarterectomy is moderately useful for symptomatic patients with 50 to 69% stenosis (Level B) and not indicated for symptomatic patients with <50% stenosis (Level A). For asymptomatic patients with 60 to 99% stenosis, the benefit/risk ratio is smaller compared to symptomatic patients and individual decisions must be made. Endarterectomy can reduce the future stroke rate if the perioperative stroke/death rate is kept low (<3%) (Level A). Low dose aspirin (81 to 325 mg) is preferred for patients before and after carotid endarterectomy to reduce the rate of stroke, myocardial infarction, and death (Level A).
Chaturvedi et al. (Tue,) studied this question.