Carotid endarterectomy: where do we stand at present?

PURPOSE OF REVIEWThe introduction of endovascular techniques and improvements in the medical management of atherosclerotic carotid lesions have led to changes in the modern management of stroke. The purpose of this review is to summarize the latest developments in surgical carotid intervention and highlight the current controversies. RECENT FINDINGSThe predominant controversies that dominate the correct surgical management of carotid atherosclerotic disease areNotwithstanding the results of the Carotid Revascularisation Endarterectomy versus Stenting Trial, does carotid artery stenting produce equivalent outcomes to surgical carotid endarterectomy? Should recent developments in best medical management of these lesions and changing socioeconomic factors restrict the indication for surgical intervention for asymptomatic lesions? What is the ideal time frame for carotid interventions in symptomatic patients? SUMMARYThere is insufficient current or historic evidence to resolve these controversies and further large randomized controlled trials are therefore required. The current knowledge limits are explored.