When is carotid endarterectomy (CEA) indicated for the treatment of atherosclerotic disease of the carotid artery?

Updated: Feb 21, 2019
  • Author: Jake F Hemingway, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Indications for carotid endarterectomy (CEA), based on prospective randomized trials, include the following:

  • Symptomatic patients with greater than 70% stenosis - Clear benefit was found in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) [1]
  • Symptomatic patients with greater than 50-69% stenosis - Benefit is marginal; appears to be greater for male patients
  • Asymptomatic patients with greater than 60% stenosis - Benefit is significantly less than for symptomatic patients with greater than 70% stenosis

Note: The percentage of stenosis used as the threshold for CEA varies among available literature. Generally, symptomatic patients with greater than 50% stenosis and healthy, asymptomatic patients with greater than 60% stenosis warrant consideration for CEA.


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