ABSTRACT
Carotid reconstruction for the treatment of carotid occlusive diseases and transient ischemic attacks (TIAs) was presented by Eastcott et al. in 1954. Diseases of the carotid circulatory system are divided into asymptomatic and symptomatic presentations. Some argue that current rates of morbidity, including stroke, and mortality among carotid stenosis patients on maximal medical therapy are comparable or even superior to 5-year rates after CEA or carotid artery stenting. The question of surgery for critical high-grade asymptomatic stenosis remained open and was the subject of considerable debate among vascular surgeons, neurosurgeons, and neurologists. A number of clinical studies, primarily retrospective, were undertaken with the goal of ascertaining the risks of long-term neurologic sequelae in patients with contralateral carotid stenosis managed non-operatively. The critical point, much as in the follow-up of asymptomatic bruits, was to determine what percentage of these patients progressed to frank stroke in the appropriate carotid distribution without warning TIAs.
