Report From the U.S. Agency for Health Care Policy and Research (AHCPR)

Carotid endarterectomy is a surgical procedure to remove atherosclerotic occlusions from the carotid artery. The surgery is usually performed in patients with transient ischemic attacks (TIAs), asymptomatic stenosis, or stroke in order to reduce stroke risk and increase cerebral blood flow. Complication rates vary widely among surgeons and hospitals, and numerous studies testing the efficacy of carotid endarterectomy and documenting its associated morbidity and mortality have produced conflicting or inconclusive results. Only the current NIH trial has demonstrated carotid endarterectomy to be better than nonoperative management of symptomatic patients with high-grade stenosis. However, there has been no definitive study concluding that asymptomatic patients benefit from carotid endarterectomy. It is generally agreed that current ongoing prospective, randomized, controlled clinical trials are likely to provide the data required to determine optimal therapy and better identify subsets of patients who are most likely to benefit from carotid endarterectomy. Until the results of these clinical trials become available, the proposed benefits of carotid endarterectomy must be regarded as indeterminate.