[Benefit-risk assessment of surgical treatment of asymptomatic carotid lesions].

In this review we draw a conclusion on the benefit and risks of the operation of asymptomatic stenotic lesions of the carotid artery referring to different pro- and retrospective studies. Long-term follow up observations on high grade carotid stenosis (> 80%) revealed an incidence of ipsilateral strokes of 2.5% per year [38], whereas after operation the incidence has been reduced to 0.2-0.5% per year [20]. The characteristics, the clinical significance of stenotic carotid lesions and the diagnostical features are summarized. Nowadays a perioperative mortality rate of 1.1% and morbidity rate (stroke) of 1.6% can be expected in experienced vascular surgical departments. Even advocates of non-operative treatment, who demanded a combined perioperative mortality and morbidity rate below 3% perceive that a prognostical benefit has been achieved within the first year after the operation. We therefore recommend the prophylactic operation for patients with asymptomatic high grade (> 80%) carotid stenosis, in ulcerative and smooth plaques, in stenosis of the contralateral side and prior or simultaneous with bypass operation, whenever there is a high expectation of life and low anaesthetic risk.