The Causes and Risk of Stroke in Patients with Asymptomatic Internal-Carotid-Artery Stenosis

Whether to perform carotid endarterectomy in asymptomatic patients is an important public health issue. On the basis of Medicare records, the number of carotid endarterectomies in the United States rose from 46,571 in 1989 to 108,275 in 1996. 1 The National Hospital Discharge Survey estimated that 144,000 endarterectomy procedures were performed in 1997 (Pokras R: personal communication). Half of the procedures are performed in asymptomatic patients. 2 Two million people in the United States who are over the age of 50 years are estimated to have asymptomatic carotid-artery stenosis of at least 50 percent of the luminal diameter. 3 Uncertainty about the ideal . . .