Abstract
We review the available evidence-based papers concerning indications for carotid endarterectomy (CEA). CEA reduces the stroke risk compared to medical therapy for patients with 70〜99% symptomatic stenosis. Male gender, age (older than 75), and study entry within 2 weeks of the last attack are the most beneficial factors for CEA. Benefits of CEA for patients with near-occlusion of the carotid artery or with amaurosis fugax were minor. There were also benefits for asymptomatic patients with 60 to 99% stenosis if the perioperative complication rate of CEA were lower than 3%. The benefits of CEA for women were fewer than for men, however, are recent prospective study (ACST) demonstrated the benefit of CEA for women as well as men. We should evaluate the native CEA complication rate and establish native CEA indications for Japanese patients.
