The surgery of extracranial vascular occlusive disease.

The task of reducing the entire field of extracranial cerebrovascular disease to a review of this brevity may be Sisyphean. The surgical therapy of extracranial cerebrovascular disease has developed into an established mode with excellent support from major clinical trials. In regards to symptomatic carotid disease, the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and the European Carotid Surgery Trial (ECST) have both strongly endorsed surgical therapy in patients with 70 to 99 percent stenosis. In the near future, results from two major asymptomatic trials, Asymptomatic Carotid Artery Stenosis Study (ACAS) and Asymptomatic Carotid Stenosis Veterans Administration Study (VA No. 167) should be available to illuminate the controversies of asymptomatic disease. Undoubtedly, new technologies such as duplex scanning and magnetic resonance angiography will have greater roles in the screening of our rapidly aging population for these diseases. Finally, vascular surgery, a major consumer of high technology in hospital resources, will be continually scrutinized by the regulating agencies in the future. It will behoove all interested parties to pursue in hospital registries for monitoring of outcome data in this evolving field.