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

Updated: Sep 29, 2021
  • Author: Jake F Hemingway, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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The following are indications for carotid endarterectomy (CEA), based on prospective randomized trials:

  • Symptomatic patients with 70-99% stenosis [24] - Clear benefit was found in the North American Symptomatic Carotid Endarterectomy Trial (NASCET); the incidence of ipsilateral stroke in 2 years was 9% with surgery and 26% with medical management [1]
  • Symptomatic patients with 50-69% stenosis [24] - Benefit is modest and appears to be greater for male patients
  • Asymptomatic patients with greater than 60% stenosis - Benefit is significantly less than for symptomatic patients with 70-99% stenosis [25]
  • Available literature includes considerable overlap in the percent of stenosis used as the threshold for CEA; in general, symptomatic patients with 50-99% stenosis and healthy, asymptomatic patients with greater than 60% stenosis warrant consideration for CEA
  • Symptomatic trials include patients with transient ischemic attacks (TIAs) or minor strokes within 3 months of entry

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