Do the facts and figures warrant a 10-fold increase in the performance of carotid endarterectomy on asymptomatic patients?

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Abstract
Carotid endarterectomy was introduced as a prophylaxis for ischemic stroke and was carried out initially on symptomatic patients. The recognition of the significance of carotid bruits, the development of noninvasive imaging of the neck arteries, and training of many surgeons capable of performing carotid endarterectomy spurred enthusiasm for its application to asymptomatic patients. The rationale for extending the procedure to patients before they have symptoms is reasonable. More patients present with stroke than with warning symptoms of a transient type. Carotid occlusion is the ultimate result of a progressing carotid stenosis. When occlusion occurs, with or without symptoms, it has the potential to deprive individuals who have poor collateral circulation of 25% of their cerebral circulation. The hope was that both stroke and occlusion might be obviated by early endarterectomy. Many surgical series, based on opinion and individual experience, began to appear, but the comparison with unoperated patients, as control subjects, was not convincing. [9,10]