Carotid Surgery in Europe: Why Do We Think Differently than in the United States?

Abstract

Carotid endarterectomy is a well-established procedure per formed throughout the world. Although its effectiveness and durability are established, many aspects of the operation are still controversial. These con troversies are depicted in daily medical practice in all countries and especial ly between vascular surgeons in the United States and the European Union. This paper describes and analyzes the main differences in opinions and prac tices on carotid endarterectomy that are emerging from the multicenter, ran domized studies performed in the two continents. Regarding symptomatic patients with high-grade internal carotid artery stenosis, there is a transat lantic agreement. Differences between the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial suggest that the degree of stenosis may only be a surrogate marker for outcome. Regarding asymptomatic patients, carotid endarterectomy is performed more frequently in the United States than in Europe. Until we can demonstrate a morbidity/mortality rate of less than 1%, carotid endarterectomy in asymp tomatic patients should be performed on a very selective basis.