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(Stroke. 2003;34:2302.)
© 2003 American Heart Association, Inc.

Comments, Opinions, and Reviews

Editorial Comment—Risk Stratification by Clinical Symptoms and Timing of Carotid Endarterectomy: How Could It Optimize Our Decision Making and Benefit Patients With Carotid Stenosis?

Neurotec Department, Karolinska Institute, Division of Geriatric Medicine, Stockholm, Sweden

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveller, long I stood

And looked down one as far as I could

To where it bent in the undergrowth;

Then took the other, as just as fair,

And having perhaps the better claim ...

The prevention of stroke by surgical means originated half a century ago.¹ In the early years, anecdotal criteria were used for the selection of patients with internal carotid artery stenosis for surgery. Within the last decade, the appropriateness of carotid endarterectomy (CEA) for the reduction of stroke risk has been demonstrated in a selected group of patients with symptomatic carotid artery stenosis. Analysis of pooled data from randomized control trials² has confirmed the unequivocal results of the North American Symptomatic Carotid Endarterectomy Trial (NASCET),³ European Carotid Surgery Trial (ECST),⁴ and Veterans Affairs Trial (VA 309).⁵ CEA is highly beneficial in patients with transient ischemic attack (TIA) and nondisabling stroke (modified Rankin score <3) with high-grade stenosis (70% diameter reduction). Within this group, CEA is most beneficial for the following patients: healthy elderly patients with hemispheric TIA, those with tandem extracranial and intracranial lesions, and those without evidence of collateral vessels. A moderate benefit has been reported in certain individuals with carotid stenosis caused by 50% to 69% diameter reduction. In the largest trial of asymptomatic subjects, the perioperative risk of stroke and death reported was very low, but results indicated that 83 subjects needed to be operated . . . [Full Text of this Article]