Carotid artery endarterectomy indications

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) found that for patients with a hemispheric or retinal TIA or a mild (non-disabling) stroke within 120 days and ipsilateral high grade stenosis (>70%), that carotid endarterectomy (CEA) reduced the rate of fatal and non-fatal strokes (by 17% at 18 months) and death from any cause (by 7% at 18 months) when compared to best medical management (when surgery was performed with perioperative risk of stroke or death of 5.8%). Results were twice as good for patients with stenosis from 90–99% than for those with 70–79%. Furthermore, with CEA the frequency of major functional impairment was reduced at 2 years.

Include:

1. progressive STROKE (“stroke in evolution”)

2. abrupt occlusion

3. tandem lesions (e.g. carotid siphon and bifurcation stenosis): although this topic remains controversial, CEA in patients with tandem lesions has not been associated with increased postoperative stroke rates. Recent case series also report success with endovascular treatment

4. progressive retinal ischemia

see BeamSAT.