High-grade carotid stenosis detected before general surgery: is endarterectomy indicated?

The risk of stroke in unselected patients and patients with a carotid bruit undergoing general anesthesia and surgery is very low. The incremental risk related to known carotid stenosis is uncertain. The authors studied 284 patients with ultrasound studies before general surgery, 224 of whom demonstrated carotid stenosis. Carotid stenosis was related to a perioperative risk of stroke of approximately 3.6%. Greater degrees of stenosis did not confer significantly higher risk. Although higher than in the unselected population, this risk does not appear sufficient to mandate prophylactic endarterectomy.