Carotid endarterectomy (CEA) is indicated in symptomatic patients with carotid artery stenosis. The NASCET trial established benefit of CEA over medical management when stenosis (measured by NASCET method) exceeds which percentage?
- A ≥50% stenosis
- B ≥70% stenosis (moderate-severe) ✓
- C ≥90% stenosis only
- D Any symptomatic stenosis regardless of degree
Correct answer: B. ≥70% stenosis (moderate-severe)
Explanation
The North American Symptomatic Carotid Endarterectomy Trial (NASCET) demonstrated that CEA provided substantial benefit over medical therapy in symptomatic patients with NASCET-measured stenosis of 70–99%, reducing the 2-year ipsilateral stroke risk from 26% (medical) to 9% (CEA). Patients with 50–69% stenosis had modest benefit. Patients with <50% stenosis had no benefit and should be managed medically. The NASCET method measures residual lumen as a proportion of the normal distal internal carotid artery, differing from the ECST method.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.