According to the ACAS trial, carotid endarterectomy is considered beneficial for ASYMPTOMATIC carotid stenosis when the degree of stenosis exceeds what threshold, provided perioperative stroke and death rates are low?

• A Greater than 50% diameter reduction
• B Greater than 70% diameter reduction
• C Greater than 60% diameter reduction ✓
• D Greater than 80% diameter reduction

Explanation

The ACAS trial showed that in asymptomatic patients with stenosis of 60% or more, endarterectomy reduced 5-year ipsilateral stroke risk from about 11% to about 5%, but only if the surgeon's perioperative morbidity was under 3%. The commonly quoted 50% figure applies to symptomatic patients in trials such as ECST analysis contexts, while 70% is the NASCET threshold for greatest benefit in symptomatic disease, which distinguishes this from the existing symptomatic-stenosis item.

Reference: Sabiston Textbook of Surgery, 21st ed.

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