According to the NASCET trial, what is the best treatment for carotid stenosis in symptomatic patients?

The NASCET trial established that carotid endarterectomy is the most effective treatment for symptomatic patients with carotid stenosis greater than 70%. This conclusion was based on evidence demonstrating that surgical intervention substantially reduces the risk of subsequent strokes compared to medical management alone for patients with significant stenosis.

Carotid endarterectomy involves surgically removing the atherosclerotic material from the carotid artery, which can dramatically improve blood flow and decrease the risk of ischemic events in symptomatic patients. The trial highlighted a clear benefit in terms of clinical outcomes, reinforcing the importance of selecting appropriate candidates for this procedure based on the degree of stenosis and the presence of symptoms.

While medical management plays a critical role in the overall care of patients with carotid artery disease, especially those with low-grade stenosis, it does not provide the same level of risk reduction for high-grade stenosis as endarterectomy does. Other treatment options, such as stenting, may not be the preferred approach in symptomatic patients with severe stenosis based on the evidence from the NASCET trial. Thus, the recommendation for carotid endarterectomy in patients with stenosis greater than 70% directly aligns with the findings of the trial, making it the best treatment