The primary purpose of carotid endarterectomy (CEA) and carotid artery stenting (CAS) is to prevent stroke. Carotid endarterectomy was first performed in the 1950s, but controversy regarding its efficacy resulted in variable acceptance, with resultant fluctuating utilization. After reaching a peak of 100 000 cases annually by the mid-1980s, referrals for CEA dropped off and the volume of procedures substantially declined over the next decade because of increasing reports of poor outcomes. The completion of several prospective, multicenter, multinational randomized clinical trials in the 1990s, including the North American Symptomatic Carotid Endarterectomy Trial (NASCET),1 the Asymptomatic Carotid Atherosclerosis Study (ACAS),2 and the Asymptomatic Carotid Surgery Trial (ACST),3 conclusively established the safety and efficacy of CEA and its superiority to best medical therapy in stroke prevention among patients with symptomatic and asymptomatic significant carotid stenoses.
Perler BA. Outcomes of Carotid Endarterectomy and Stenting in Elderly Patients. JAMA. 2014;311(12):1244-1245. doi:10.1001/jama.2014.908