Carotid Endarterectomy in Patients with Asymptomatic Carotid Stenosis

Surgical therapy of stroke is directed at prevention of ischemic events; in the vast majority of cases this effort involves carotid endarterectomy. As such, emphasis has been placed on identification of patients likely to suffer stroke in the future. In patients with transient cerebral ischemia or small fixed deficits, increased risk for subsequent ischemic events is recognized and the role of surgery is generally accepted. Management of patients who have had no neurologic symptoms is more controversial. The debate on this issue involves many unresolved, complex questions (See Table 15.1). Included in this list are definitions of the term asymptomatic, identification of clinically important lesions, natural history of carotid stenosis, and the effect of surgical intervention (i.e., carotid endarterectomy) on both short-term and long-term outcome.