The NASCET trial established the benefit of carotid endarterectomy (CEA) in symptomatic carotid stenosis. The greatest absolute risk reduction in stroke was demonstrated for stenosis of what degree?

• A 30–49% symptomatic stenosis
• B 50–69% symptomatic stenosis
• C Near-occlusion (string sign)
• D 70–99% symptomatic stenosis ✓

Explanation

The NASCET trial demonstrated the greatest absolute risk reduction from CEA for ipsilateral stroke in patients with symptomatic 70–99% stenosis — 2-year ipsilateral stroke risk was 26% with medical therapy alone versus 9% with CEA, an absolute risk reduction of 17%. For 50–69% stenosis, CEA provides a modest benefit; for <50% stenosis or near-occlusion, medical therapy is preferred. Near-occlusion has counterintuitively reduced stroke risk due to very low flow, so CEA benefit is uncertain in this subset.

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

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Written and medically reviewed by the StethoPrep medical team.