ABSTRACT
Results from two large randomized trials have shown that carotid endarterectomy combined with best medical treatment significantly reduces the risk of recurrent stroke in recently symptomatic patients (2,3). In the European Carotid Surgery Trial (ECST), 30-day outcomes following surgery were associated with a death or major stroke rate of 7.5%. The corresponding rate in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) was 6.5%. These complications rates, whilst acceptable, leave room for improvement. The NASCET study also reported an 8.9% risk of wound complication, 7.5% risk of cranial nerve injury, and 0.9% risk of myocardial infarction. It is difficult to generalize the results from large multicenter trials to everyday clinical practice in individual centers where there may be much less experience with the technique of carotid endarterectomy (4). This is particularly important as the benefit of carotid surgery relies on the balance between stroke prophylaxis and the risk of stroke or death at the time of the procedure.
