[3] Unlike asymptomatic patients, symptomatic people with moderate carotid stenosis (50–69%) still benefit from endarterectomy, albeit to a lesser degree, with a number needed to treat of 22 at five years.

[4][5] In addition, co-morbidity adversely affects the outcome: people with multiple medical problems have a higher post-operative mortality rate and hence benefit less from the procedure.

[3] Asymptomatic people have narrowing of their carotid arteries, but have not experienced a transient ischemic attack or stroke.

Long term complications include restenosis of the endarterectomy bed, although the clinical significance of this is controversial in asymptomatic patients.

The internal, common and external carotid arteries are carefully identified, controlled with vessel loops, and clamped.

At present there is still ongoing debate related to difference in outcome between local and general anaesthesia, and methods of determining the need for a shunt.

[9] The endarterectomy procedure was developed and first done by the Portuguese surgeon Joao Cid dos Santos in 1946, when he operated an occluded subsartorial artery, at the University of Lisbon.

The first endarterectomy was successfully performed by Michael DeBakey around 1953, at the Methodist Hospital in Houston, TX, although the technique was not reported in the medical literature until 1975.

[12] Eastcott's procedure was not strictly an endarterectomy as we now understand it; he excised the diseased part of the artery and then resutured the healthy ends together.