Indication for carotid endarterectomy?

Indication for carotid endarterectomy?

• A. Endarterectomy for all patients regardless of stenosis
• B. Asymptomatic stenosis greater than 60%
• C. Symptomatic stenosis greater than 50% or asymptomatic greater than 60%
• D. Symptomatic stenosis greater than 10%

Answer: (C)

The idea is to reduce the risk of recurrent stroke by removing the plaque when the brain’s blood supply is at risk, but only in patients who are likely to benefit enough to outweigh surgical risks. In patients who have had a TIA or nonfatal stroke on the same side as the blockage (symptomatic), carotid endarterectomy is recommended if the stenosis is at least 50%, especially when the procedure can be done promptly after the event and the patient’s operative risk is low. For patients without symptoms (asymptomatic), the benefit is more modest, so surgery is generally considered only when the stenosis is high—typically greater than 60%—and the patient is a good candidate for surgery with low perioperative risk. These thresholds come from balancing the potential reduction in stroke risk against the risks of the operation, and they assume accurate measurement of stenosis (NASCET criteria) and optimized medical therapy. Therefore, the indication described—symptomatic stenosis greater than 50% or asymptomatic greater than 60%—best fits when deciding on endarterectomy.

The idea is to reduce the risk of recurrent stroke by removing the plaque when the brain’s blood supply is at risk, but only in patients who are likely to benefit enough to outweigh surgical risks. In patients who have had a TIA or nonfatal stroke on the same side as the blockage (symptomatic), carotid endarterectomy is recommended if the stenosis is at least 50%, especially when the procedure can be done promptly after the event and the patient’s operative risk is low. For patients without symptoms (asymptomatic), the benefit is more modest, so surgery is generally considered only when the stenosis is high—typically greater than 60%—and the patient is a good candidate for surgery with low perioperative risk. These thresholds come from balancing the potential reduction in stroke risk against the risks of the operation, and they assume accurate measurement of stenosis (NASCET criteria) and optimized medical therapy. Therefore, the indication described—symptomatic stenosis greater than 50% or asymptomatic greater than 60%—best fits when deciding on endarterectomy.