Carotid intervention 1: who should be treated?

Stroke is a major cause of morbidity and mortality in the modern world. Carotid artery atheromatous disease is responsible for a significant number of these events. The effects of carotid artery disease may be prevented by appropriate treatment. All patients with known atheromatous disease should be treated with medical therapy. Despite this, some patients remain at high risk of stroke, which may be reduced by the selective use of additional therapies such as carotid endarterectomy or carotid stenting. Patients who have had recent neurological symptoms, attributable to their carotid disease, may benefit most from these additional treatments, particularly if the treatment is performed soon after the event. The operation needs to be performed with low complication rates. Some groups of patients who have been free of neurological symptoms may also benefit from these additional therapies, but these patients have a much lower inherent risk of stroke, and so the potential benefits are less. In such circumstances it is even more important that the operations are performed with minimal morbidity. Patients undergoing coronary artery bypass grafts, who also have carotid disease, are at elevated risk of stroke, and it is common practice to treat both conditions. There is no strong data to support this practice.