and Purpose-The validity of carotid endarterectomy (CEA) for asymptomatic carotid stenosis has been questioned recently due to the increasing effectiveness of medical management. In this study, we evaluated how contemporary outcomes of CEA for asymptomatic carotid stenosis compare with published stroke rates for best medical management. Methods-We identified all patients who underwent CEA for asymptomatic carotid stenosis from the 2005, 2006, and 2007 National Surgical Quality Improvement

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... m (NSQIP) database. Pre-and postoperative variables, including 30-day stroke, death, and myocardial infarction, were analyzed. Results-Of 10 423 carotid endarterectomies identified, 5009 were for asymptomatic carotid stenosis. The stroke, death, and myocardial infarction rates of this group were 0.96%, 0.56%, and 0.22%, respectively. If the 0.96% perioperative stroke rate from our contemporary NSQIP analysis is combined with the 5-year stroke risk after CEA of 3.8% from the Asymptomatic Carotid Surgery Trial, the average annual stroke rate is 1%, comparable to the stroke rate of 0.8% for best medical management from the Second Manifestations of Arterial Disease Study trial. Conclusions-These contemporary results show that stroke rates with CEA and best medical management for asymptomatic stenosis are similar. Despite limitations, our results emphasize the importance of continuing randomized prospective trials comparing CEA and best medical management for asymptomatic carotid stenosis. (Stroke. 2010;41: 975-979.)