Very few operations have been subject to more scientific scrutiny than carotid endarterectomy (CEA). Since its introduction in the 1950s, CEAs have been performed in great numbers with the goal of preventing ischemic stroke. In the mid 1980s concern about over utilization of CEA and reports of excessive perioperative stroke morbidity and mortality prompted the initiation of several multicenter, randomized trials designed to evaluate the efficacy of CEA. As the results of these trials became available, the number and frequency of CEA in the United States increased significantly. However, now a new wave of uncertainty has arisen related to the availability of an alternative to CEA, carotid angioplasty and stent (CAS). Now, more than ever, there is uncertainty as to the proper management of carotid artery stenosis. In this review we summarize the existing data regarding the efficacy of CEA and compare these data to a critical analysis of the recent results of CAS.
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