Carotid & Cerebrovascular

Symptomatic carotid stenosis is a 50–99% NASCET internal carotid artery stenosis causing ipsilateral amaurosis fugax, TIA or non-disabling ischaemic stroke within the last 6 months. The key decision is CEA candidacy and timing. UK vascular audit/NVR uses symptom-to-CEA within 14 days; the National Clinical Guideline for Stroke target is within 7 days; ESVS says preferably within 14 days.

CEA has its clearest benefit in recently symptomatic 70–99% stenosis without near-occlusion; delay reduces that benefit. In asymptomatic disease, comparing two procedures does not establish whether intervention is needed.