Ischemic stroke: Update on prevention part 1, surgery, stenting, or medical therapy?

When carotid endarterectomy is performed by a surgeon whose perioperative morbidity/mortality rate is less than 6%, it is more effective than medical therapy in preventing stroke in symptomatic patients who have stenosis of 50% or greater; the procedure is more effective than medical therapy in asymptomatic patients with stenosis of 60% or greater when the surgeon has a perioperative morbidity/mortality rate of less than 3%. Consider carotid angioplasty and stenting in symptomatic patients 80 years or younger who have stenosis of 50% or greater and 1 or more high-risk features and in asymptomatic high-risk patients who have stenosis of 80% or greater. Medical therapy is superior to invasive procedures in symptomatic patients with stenosis of 50% or less and in asymptomatic patients with stenosis of less than 60%.