Stroke prevention by surgery for symptomatic disease in carotid territory.

The benefit of surgical procedures in preventing stroke is of concern to physicians, surgeons, and all health-care providers. The multicenter randomized trial has been applied in evaluating these strategies. Extracranial-intracranial anastomosis has failed to measure up to this rigid form of scientific scrutiny and the reasons for the demise of this procedure are reviewed. By contrast, for symptomatic disease of the internal carotid artery, patients with very severe stenosis are better treated by endarterectomy than with medical care alone. The ongoing North American Symptomatic Carotid Endarterectomy Trial (NASCET) is reviewed and the compelling reasons to continue the trial for patients with moderate disease are outlined.