Surgery for carotid artery stenosis: Cut-off point is problematic in selecting patients for carotid surgery

EDITOR-Toole's voice is important in the controversial debate on carotid surgery. 1 However, in determining a cut-off point for selecting patients for endarterectomy, the different methods of measurement (local versus distal degree of stenosis) used by European and American surgery trials must be considered. 2 A cut-off point of 60% stenosis refers to the asymptomatic carotid artery stenosis study (ACAS) and uses the American method of stenosis measurement 3 ; that degree of stenosis corresponds to a 75% stenosis according to European criteria. 2 Therefore, to define a cut-off point of 60% stenosis in a European journal is misleading.