American Academy of Neurology Recommendations, 2005
For asymptomatic patients with 60 to 99% stenosis, the benefit/risk ratio is smaller compared to symptomatic patients and individual decisions must be made. Endarterectomy can reduce the future stroke rate if the perioperative stroke/death rate is kept low (3%).
American Heart Association Recommendations, 2001
Endarterectomy may be considered in patients with high-grade asymptomatic carotid stenosis performed by a surgeon with less than 3% morbidity/mortality rate. (Level of Evidence I, Grade A)
Hobson, RW 2d, Weiss, DG, Fields, WS, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med 1993; 328:221.
Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA 1995; 273:1421.
Halliday, A, Mansfield, A, Marro, J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363:1491.
Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis. Mayo Asymptomatic Carotid Endarterectomy Study Group. Mayo Clin Proc 1992; 67:513.
Chaturvedi , S, Bruno, A, Feasby , T, et al. Carotid endarterectomy--an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2005; 65:794.
Goldstein, LB, Adams, R, Becker, K, et al. Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 2001; 32:280.
Barnett, HJM, Taylor, DW, Eliasziw , M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998; 339:1415.
LaRosa J.C., Grundy S.M., Waters D.D., Shear C., Barter P., Fruchart J.C., Gotto A.M., Greten H., Kastelein J.J., Shepherd J., Wenger N.K.: Treating to New Targets (TNT) Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease N Engl J Med 352. 1425-1435.2005;