In carotid endarterectomy (CEA) for symptomatic carotid stenosis, the NASCET trial criteria for significant stenosis and the timing of surgery are both important. NASCET showed greatest benefit when CEA is performed for symptomatic stenosis in which range, and within what timeframe?

• A 70–99% stenosis, within 2 weeks of TIA/minor stroke for maximum benefit ✓
• B 50–69% stenosis within 2 weeks of TIA/minor stroke
• C 70–99% stenosis, any time within 6 months of symptoms
• D >50% stenosis, within 24 hours of symptom onset

Explanation

NASCET demonstrated absolute risk reduction of 17% at 2 years (26% to 9%) for CEA vs medical therapy in patients with 70–99% symptomatic carotid stenosis. The risk of recurrent stroke is highest in the first 2 weeks post-TIA/stroke (highest early risk in 'unstable' plaque). Current guidelines (ESO/AHA) recommend CEA within 2 weeks (ideally <48–72 hours in neurologically stable patients) to capture maximum benefit. For 50–69% stenosis, absolute benefit is smaller and timing is less critical.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.