What did the NASCET trial indicate is the best treatment for symptomatic carotid stenosis?

The NASCET (North American Symptomatic Carotid Endarterectomy Trial) established that carotid endarterectomy is the most effective intervention for patients with symptomatic carotid stenosis, specifically those with greater than 70% narrowing of the artery in diameter. The trial demonstrated significant benefits in reducing the risk of stroke when comparing the outcomes of surgical intervention to medical management alone, particularly in symptomatic patients.

The focus on stenosis greater than 70% in diameter is crucial because this threshold was shown to correlate with a high risk of recurrent strokes; thus, surgical intervention is warranted to effectively remove the troublesome plaque and restore blood flow. This finding has influenced clinical guidelines and the treatment approach for symptomatic carotid stenosis, reinforcing the importance of surgical options in managing high-risk patients. The conclusions of the NASCET trial have been foundational in the establishment of treatment protocols for carotid artery disease, particularly in symptomatic patients.