Management of Carotid Stenosis (Treatment Options 3)

G. Patrick Clagett, M.D. Carotid Endarterectomy: The patient in the case vignette is an ideal candidate for carotid endarterectomy to prevent stroke because of the favorable benefit-to-risk ratio. Two large-scale, rigorous trials evaluating the use of carotid endarterectomy in asymptomatic patients with advanced stenoses (>60%) reached similar conclusions despite being carried out on different continents a decade apart.1,2 In both, as compared with the best medical therapy, the use of carotid endarterectomy resulted in a significantly reduced rate of stroke and death at 5 years (absolute risk reduction, 5.4 to 5.9%; relative risk reduction, 46.0 to 53.0%; P<0.001).>