[Therapeutic concept in asymptomatic carotid stenosis: surgical indications from the neurologic viewpoint in comparison with spontaneous course].

The annual risk of stroke from asymptomatic carotid stenosis is about 0.5-2.5%. After successful carotid endarterectomy (CEA) the risk of suffering a stroke amounts to about 2% per year. CEA therefore seems to impose an unnecessary risk upon the patient. However, a stenosis with more than 80% luminal narrowing, a rapidly progressing stenosis, and ulcers may increase the spontaneous risk and should be evaluated in randomized studies. The same applies to prophylactic CEA of asymptomatic stenosis before major cardiac or vascular surgery.