Carotid endarterectomy

Carotid endarterectomy is a treatment for stenosis of the carotid artery, where the stenotic plaque is removed whilst blood flow is shunted to maintain cerebral perfusion.

NICE have stated that (1):

Urgent carotid endarterectomy

• ensure that people with stable neurological symptoms from acute non-disabling stroke or TIA who have symptomatic carotid stenosis of 50 to 99% according to the NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria:
  • are assessed and referred urgently for carotid endarterectomy to a service following current national standards
  • receive best medical treatment (control of blood pressure, antiplatelet agents, cholesterol lowering through diet and drugs, lifestyle advice)
• ensure that people with stable neurological symptoms from acute non-disabling stroke or TIA who have symptomatic carotid stenosis of less than 50% according to the NASCET criteria, or less than 70% according to the European Carotid Surgery Trial (ECST) criteria:
  • do not have surgery
  • receive best medical treatment (control of blood pressure, antiplatelet agents, cholesterol lowering through diet and drugs, lifestyle advice).

Reference:

1. NICE. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline NG128. Published May 2019, last updated April 2022