Carotid endarterectomy: Who is the high-risk patient?

Louis L. Nguyen, Michael S. Conte, Amy B. Reed, Michael Belkin

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


The role of carotid endarterectomy in the prevention of stroke was validated by two randomized clinical trials, the North American Symptomatic Carotid Endarterectomy (NASCET) and the Asymptomatic Carotid Atherosclerosis Study (ACAS). However, these trials excluded patients at high risk for perioperative stroke and other morbidity, raising concerns for the applicability of the trial results to the general population. Some have also suggested these "high-risk" patients are better suited for carotid artery stenting with the belief that stenting has lower morbidity and mortality. In this article, we review many of the commonly accepted high-risk factors for carotid endarterectomy (CEA) and examine their outcomes. High-risk patients are more common than generally believed and their outcomes may be the same with carotid endarterectomy as it is with carotid stenting. Truly "high-risk" patients with shortened life expectancy are best served with no intervention.

Original languageEnglish (US)
Pages (from-to)219-223
Number of pages5
JournalSeminars in vascular surgery
Issue number3
StatePublished - Sep 2004
Externally publishedYes


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