The surgical management of carotid artery disease.

A reduction in the incidence of strokes among the general population requires recognition and effective management of those who are at greatest risk for stroke. Surgical management of carotid artery disease is a valuable therapeutic approach, and is probably more effective than medical management in preventing strokes in certain patients. Not every patient is a candidate for surgery, and the surgeon must carefully weight the risks of angiography and surgery versus the risks of a stroke. Those patients at greatest surgical risk are those with significant coronary artery disease and those who are neurologically unstable. Carotid endarterectomy should only be considered if an experienced angiographer and surgeon who routinely perform this procedure with good results are available. Older patients scheduled for major surgery should be evaluated for carotid artery disease regardless of the presence of a bruit, particularly if they show evidence of atherosclerosis alsewhere. Noninvasive carotid studies are very valuable in assessing patients. With proper selection, carotid endarterectomy can decrease the incidence of the devastating stroke.