The choice of procedure depends on the location and extent of the disease segment, presence of clots and cardiac risk.
Timing of surgery depends on extent of damage (infarct) in the brain due to the current episode as well as the severity of the narrowing. If the area of damage is small, one performs the procedure at the earliest. If the area is large, one waits for 4 weeks for the area to heal unless the disease is so severe that there is a risk of another stroke during the waiting period.
It is known (NASCET and ECST trial) that when the narrowing exceeds 70% and there are symptoms the risk of another stroke is almost 27% within 2 years if treated only with medicines and the risk reduces to 9% if treated surgically.
It there are no symptoms and the narrowing is > 80% then the risk of a stroke within 2 years is 10% if treated only with medicines as against 5% if treated surgically (ACAS Trial).
Choice between open surgery and Angioplasty-stenting depends on location, extent of disease with amount of calcification, age of the patient and risk factors that influence decision making. Both procedures give good results in symptomatic and asymptomatic carotids if the patient selection is done properly.