Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis

In 1954 a patient with symptoms suggesting that a stroke was imminent underwent successful removal of a stenosed segment of the carotid artery. 1 From that initial experience, carotid endarterectomy evolved. In 1985 it was performed 107,000 times in the United States. 2 Two negative randomized trials were reported. 3 , 4 On the basis of anecdotal evidence, about 1 million endarterectomies were performed worldwide between 1974 and 1985. 5 , 6 Reports of unacceptable rates of complications, reviews of health care data bases, and editorials called into question the benefit of endarterectomy. 7 – 13 The failure of cerebral bypass surgery in a randomized trial strengthened the . . .