Carotid endarterectomy is highly beneficial for patients with recent hemispheric, transient ischemic attacks or non-disabling strokes and ipsilateral high-grade (70-99%) stenosis."1 This conclusion stemmed from an interim analysis of results from the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and has been widely hailed as confirmation of the efficacy of surgery in preventing strokes. A brief review of the background for this report is in order.
During the past several years, reports in the scientific and lay press and on national television have been critical of the use of carotid endarterectomy in the treatment of patients with extracranial cerebrovascular disease, raising concerns as to its effectiveness in preventing strokes, alleging its overuse, and quoting statistics on mortality and morbidity rates that are unacceptably high.2
A number of measures were suggested to study these allegations. High on the list was the call for a prospective randomized controlled trial of
THOMPSON JE. Benefits of Carotid Endarterectomy Confirmed by Randomized Trial. Arch Surg. 1991;126(10):1178-1179. doi:10.1001/archsurg.1991.01410340016002