[Should asymptomatic carotid artery stenoses be operated?].
Compared to asymptomatic stenoses, asymptomatic carotid artery stenoses are associated with a relatively low risk of ipsilateral cerebral infarction: approximately 2% per year for stenoses reducing the diameter of the arterial lumen by 60% or more. The benefit of surgery is therefore limited. In the ACAS study, the risk of ipsilateral cerebral infarction was reduced by 50% by surgery, which corresponds to an absolute reduction of the risk of only 1% per year. Carotid endarterectomy should therefore be reserved for patients presumed to be at greater risk of cerebral infarction (stenosis greater than 80%, haemodynamic repercussions), provided that the patient's age and life expectancy are compatible with long-term prevention and that this treatment can be conducted at a low risk. In every case, the patient must be precisely informed about the expected benefits and risks of this operation.
Mas
J L
JL
Service de Neurologie, Centre Raymond Garcin, Hôpital Sainte-Anne, Paris.
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000601:surgery*; D002544:Cerebral Infarction / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors