Fig. 4: Thirty-day rate of perioperative stroke or death in surgically treated patients with contralateral occlusion and those with only contralateral stenosis. Data are for patients with either asymptomatic or symptomatic stenosis in the ASA and Carotid Endarterectomy (ACE) trial6 and symptomatic patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET).3 The high risk (12.3%) for asymptomatic patients with contralateral occlusion would recommend strongly against carotid endarterectomy for patients with this combination of lesions. The numbers of patients were as follows: asymptomatic patients in ACE trial, 1358 with stenosed and 154 with occluded contralateral artery; symptomatic patients in ACE trial, 1210 with stenosed and 82 with occluded contralateral artery; symptomatic patients in NASCET, 1354 with stenosed and 61 with occluded contralateral artery. Reproduced, with permission, from Inzitari D, Eliasziw M, Gates P, Sharpe BL, Chan RKT, Meldrum HE, et al, for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. The causes and risk of stroke in subjects with an asymptomatic internal carotid artery. N Engl J Med 2000;342:1693-700. Copyright © 2000 Massachusetts Medical Society. All rights reserved.