Symptomatic carotid artery stenosis: a solvable problem. North American Symptomatic carotid Endarterectomy Trial.

Last year, the first report appeared from the North American Symptomatic Carotid Endarterectomy Trial (NASCET). An editorial in Stroke remarked enthusiastically upon the results. Striking benefit could be attributed to surgery. The positive result applied only to symptomatic patients who had a very tight stenosis. In terms of stroke, this subgroup of patients treated without surgery proved to have an extremely grave outlook. Stemming directly from this poor outlook and because of low rates of perioperative complications, the 30-day and the 2-year differences in stroke between the medically treated patients and those in the surgical arm were compelling. This difference exceeded by a factor of three, if not four, that which had been anticipated by contemporary knowledge and opinion. Accordingly, this phase of NASCET was concluded 3 years earlier than had been projected at the onset of the trial. The European Carotid Surgery Trial (ECST), with some differences in design and execution, reached comparable conclusions and also stopped the entry of patients with severe stenosis.