With what to treat which patient with recently symptomatic carotid stenosis?

INTRODUCTION Carotid endarterectomy is the most frequently performed vascular surgical procedure in the USA, and the rates are rising in Europe (Tu et al . 1998; Hsia et al . 1998). About half of ischaemic strokes are caused by atherothrombo-embolism (Sandercock et al. 2003), the majority related to atheroma in the extracranial arteries in white people, often at the origin of the internal carotid artery (ICA). The risk of stroke is relatively low distal to an asymptomatic carotid stenosis (Rothwell et al . 1995), but is markedly increased, at least for a few years, in patients who present with a transient ischaemic attack (TIA) or minor ischaemic stroke in the territory of a stenosed carotid artery. Most of the strokes that occur within the first few years after a TIA or minor ischaemic stroke in patients with carotid stenosis are ischaemic and in the territory of the symptomatic artery – i.e. ipsilateral ischaemic stroke.