Prevention

Consider performing carotid endarterectomy in patients with carotid stenosis > 50% ^a

Why?

• Though there is a small increased risk of early disabling stroke or death following carotid endarterectomy, in the long-term it reduces stroke and death. ^a
• It is cost-effective in symptomatic patients. ^d

Carotid endarterectomy reduces stroke and death in patients with symptomatic carotid stenosis > 70%

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
symptomatic carotid artery stenosis > 70% a	carotid endarterectomy	medical therapy	disabling stroke or death at 12 months	14%	0.48 (0.33 to 0.70)	15 (11 to 27)
symptomatic carotid artery stenosis 50%-69%				18%	0.69 (0.51 to 0.94)	21 (13 to 110)
symptomatic carotid artery stenosis < 50%				11%	1.23 (1.0 to 1.51)	-44 (infinity to -21)
symptomatic carotid artery stenosis a			disabling stroke or death at 30 days	1.2%	2.23 (1.55 to 3.22)	-72 (-160 to -40)