ABSTRACT
The reports of both the ACAS and NASCET trials have resulted in reaffirmation of principles of carotid surgery long held by vascular surgeons: that high-grade carotid stenosis and symptomatic lesions present a risk of stroke and that this risk may be reduced by carotid endarterectomy. The embolic theory of stroke-that emboli originating from carotid lesions result in clinical symptoms of transient ischemic attack, amaurosis, and stroke-has been reinforced by these trials. Furthermore, the recognition that the development of a carotid ulcer represents the footprint of repeated emboli has lent support to endarterectomy for carotid ulcerations. The current discussion regarding carotid ulceration revolves not about whether these lesions should be repaired, but when they should be repaired.
