Carotid endarterectomy.

Abstract

Carotid endarterectomy is a surgical procedure to remove atherosclerotic occlusions from the carotid artery. The surgery is usually performed in patients with transient ischemic attacks (TIAs), asymptomatic stenosis, or stroke in order to reduce stroke risk and increase cerebral blood flow. Complication rates vary widely among surgeons and hospitals, and numerous studies testing the efficacy of carotid endarterectomy and documenting its associated morbidity and mortality have produced conflicting or inconclusive results. No properly designed prospective clinical trial has convincingly demonstrated this surgery to be superior or inferior to nonoperative management for any subset of patients with carotid artery disease. There has been no definitive study concluding that patients with TIA benefit from carotid endarterectomy. The benefits for asymptomatic patients are even less clear. Among the alternative surgical and medical treatments advocated for occlusive carotid disease, none has clearly demonstrated superior therapeutic results. It is generally agreed that current ongoing prospective, randomized, controlled clinical trials are likely to provide the data required for determination of optimal therapy and better identify subsets of patients who are most likely to benefit from carotid endarterectomy. Until the results of these clinical trials become available, the proposed benefits of carotid endarterectomy must be regarded as indeterminate.