Endarterectomy for Asymptomatic Carotid Artery Stenosis

Since its inception in the 1950s, carotid endarterectomy has been widely applied as a means to prevent cerebral infarction. The removal of stenotic or ulcerated lesions at the cervical carotid bifurcation appeared to be a logical and practical approach to stroke prevention. However, the appropriateness of this operation became a matter of controversy in the mid 1980s,¹,²in part because of the lack of objective data demonstrating the efficacy of carotid endarterectomy in preventing stroke. Subsequent to that time, six prospective, randomized trials for endarterectomy have been reported,³⁻⁸five of which have shown benefit for surgery in preventing cerebral ischemia. Three trials⁴⁻⁶randomized patients with symptomatic carotid stenosis (ie, transient ischemic attack, amaurosis fugax, or small completed stroke ipsilateral to the carotid narrowing). Several notable features were common to all three trials of symptomatic carotid stenosis. First, carotid endarterectomy provided significant protection against subsequent ipsilateral stroke in