Carotid endarterectomy benefits and risks of the procedure is required on an individual patient basis. Peri-operative CEA risks for combined 30 day mortality and stroke risk should be < 3% for asymptomatic patients and ≤ 6% for symptomatic patients. Symptomatic patients typically have either transient ischemic attack (TIA) or minor stroke, defined as a focal neurologic defect affecting one side of the body, speech, or vision. Asymptomatic patients have narrowing of their carotid arteries, but have not experienced a TIA or stroke. Carotid stenosis is diagnosed with ultrasound doppler studies of the neck arteries, magnetic resonance angiography (MRA) or computed tomography angiography
Carotid endarterectomy 7 carotid stent systems as safe and effective in patients at increased risk of complications for carotid surgery and 1 carotid stent system for patients at average or usual risk of carotid surgery. The SAPPHIRE study of patients at high surgical risk for carotid surgery demonstrated non-inferiority for carotid stenting compared to carotid surgery. The CREST trial, the largest trial comparing carotid surgery to carotid stenting in over 2,500 patients found that carotid artery stenting resulted in a stroke rate of 6.4% versus 4.7% for endarterectomy at 4 years. However, carotid endarterectomy was associated with a slightly higher rate of