Carotid endarterectomy was first performed in the 1 950s and has evolved as the current gold standard of care for the appropriate patient. The historical path of the operation, which is detailed in this article, shows a waxing and waning of enthusiasm depending upon the results of both prospective trials and population based studies. A review of these publications provides not only support for carotid endarterectomy but also a template for the acceptance of any new therapy (ie, carotid angioplasty and stenting). To date, stenting has not yet completed this required journey and thus has not achieved equipoise with the established gold standard of endarterectomy.
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