In subgroup analysis, the benefits of CEA were confined to patients <75 years of age. The National Institute of Neurological Disorders and Stroke sponsored Carotid Revascularization of Primary Prevention of Stroke (CREST-2) trial will be comparing centrally managed, intensive medical therapy with or without CEA.526 Careful screening of surgeons participating in clinical trials might lead to results that cannot be generalized to the com- munity. This is particularly evident when the complications from angiography are removed from the surgical group. When this is done, the 30-day rate of stroke and death for CEA in ACAS was 1.54%.517 The perioperative complication rate in ACST was 3.1%. The results of CEA for asymptomatic patients were exam- ined in the National Hospital Discharge Database for 2003 The rate of the combination of stroke and death for CEA was 1.16%. This compares favorably with the rate of the combination of stroke and death for carotid artery stent/angioplasty during the same interval, which was 2.24%. These estimates, however, are based on administrative data and are limited to the procedural hospitalization. A 10-state survey of 30-day complication rates after CEA performed in asymptomatic patients a few years earlier found rates that Thus, it would appear the perioperative complication rates for CEA found in the ACAS trial could be similar or better in the com- munity; however, in at least some areas, rates may be higher. More recently, complication rates from the CREST trial were CEA in asymptomatic patients carried a com- bined risk of stroke and death of 1.4%. Additionally, a registry maintained by the Society for Vascular Surgery documented a 30-day postoperative combined rate of stroke and death of This rate among unselected surgeons was compa- rable to the rate seen among surgeons selected to participate in a trial. 