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May 1994

Carotid Surgery and Stroke Prevention

Author Affiliations

Memphis, Tenn

Arch Neurol. 1994;51(5):455-456. doi:10.1001/archneur.1994.00540170027012

Carotid endarterectomy for carotid stenosis of 70% or more is the treatment of choice to prevent stroke in any brain vascular territory as well as ipsilaterally in patients presenting with symptoms of transient monocular blindness, transient cerebral ischemia, and small disabling stroke providing the surgical stroke morbidity is 3% or less and the stroke mortality is 1% or less. To date, this scenario is the only scientifically proven indication for the operation. Under these circumstances, there is an absolute risk reduction of stroke in favor of surgery of 17% and a relative risk reduction of 65% when compared with the best medical therapy.

Two major prospective randomized studies for symptomatic and asymptomatic carotid stenosis are in progress. The North American Symptomatic Carotid Endarterectomy Trial continues to accrue and analyze the surgical results in patients presenting with transient cerebral ischemic attacks and small nondisabling stroke with ipsilateral carotid stenosis of 30%