Based on moderate quality evidence, the authors recommend carotid endarterectomy (CEA) in patients with ≥60–99% asymptomatic carotid stenosis considered to be at increased risk of stroke on best medical treatment (BMT) alone. They also recommend CEA for patients with ≥70–99% symptomatic stenosis, and they suggest CEA for patients with 50–69% symptomatic stenosis. Based on high quality evidence, CEA should be performed early, ideally within two weeks of the last retinal or cerebral ischaemic event in patients with ≥50–99% symptomatic stenosis. Based on low quality evidence, carotid artery stenting (CAS) may be considered in patients < 70 years old with symptomatic ≥50–99% carotid stenosis. The results of another large trial comparing outcomes after CAS versus CEA in patients with asymptomatic stenosis are anticipated in the near future, that may influence treatment practices.
Our mission: To reduce the burden of cardiovascular disease.