Technical issues in carotid artery surgery 1995.

In reviews in the 1980s, we discussed both indications for and surgical techniques in carotid endarterectomy. Significant changes in the practice of extracranial cerebrovascular reconstruction have occurred over the past few years. The newest indications and cooperative study data have recently been discussed by Camarata and Heros in this topic review series. In this article, we aim to review the advances in operative monitoring and surgical techniques of the last decade. We would be remiss, however, not to note that the latest Asymptomatic Carotid Atherosclerosis Study data, released in September 1994, indicate that carotid endarterectomy is significantly superior to medical therapy for asymptomatic stenosis of > 60%. These data, along with the North American Symptomatic Carotid Endarterectomy Trial results, will revitalize and lend scientific validity to carotid artery reconstruction.