ABSTRACT
Based on the Asymptomatic Carotid Atherosclerosis Study (ACAS) and the Asymptomatic Carotid Surgery Trial (ACST), current American Stroke Associ ation evidence-based recommendations support carotid endarterectomy (CEA) in selected patients with 60-99% asymptomatic carotid stenosis if performed by a surgeon with a 3% surgical complication rate. Patient selection criteria regarding comorbid conditions, life expectancy, patient preference, and demographics, including gender, are crucial.1 It is also recommended that other treatable causes of stroke are thoroughly investigated and intensive medical therapy instituted for coexisting medical conditions. These recommendations for endarterectomy are given class IA grade based on the weight of evidence from two randomized trials.
