Patient: I have been suffering from diabetes for about 15 years and had a successful bypass surgery on August 14, 2008. 2008 ultrasound revealed bilateral stenosis of the strong arteries, 50% and 70% respectively. Now my stomach is not good. I have been drinking 100 mg of aspirin and other heart medications daily since my heart surgery. Which is better in this case, CAS or CEA. What day is convenient to go recently? Doctor: The internationally accepted “gold standard” for the treatment of carotid stenosis is carotid endarterectomy. CAS has been developing rapidly in China in recent years, but so far there have been no major international clinical trials to prove that CAS can replace CEA. The American Heart Association (AHA) and the Stroke Association (ASA) have launched the The “Expert Consensus on Reconstruction in Patients with Symptomatic Carotid Stenosis” clearly recommends CEA for severe carotid stenosis as a Class I recommendation with Class A evidence. The European standard ESVS guideline “Indications and techniques for invasive treatment of carotid stenosis” also clearly states that CEA is a Class A recommendation for patients with symptomatic carotid stenosis. The “Guidelines for the management of ischemic stroke and transient ischemic attack (2008)” published by the Executive Committee of the European Stroke Organization (ESO), the recently published “Management of carotid atherosclerotic disease: a clinical practice guideline of the American College of Vascular Surgeons”, and the “Clinical management of acute stroke” published in Australia. The recently published “Management of Carotid Atherosclerotic Disease: Clinical Practice Guidelines of the American College of Vascular Surgeons” and the Australian “Guidelines for the Clinical Management of Acute Stroke” are generally consistent with the above “Expert Consensus” and also limit CAS to high-risk patients who are not suitable for CEA. Professor Zhou Dingbiao, a famous neurosurgeon and the chief member-elect of the Chinese neurosurgery committee, also wrote an article in the Chinese Journal of Neurosurgery, Vol. 25, No. 3, 2009, clearly affirming that CEA is the “gold standard” for the treatment of carotid artery stenosis. In your case, I will see the patient and review the films before making a decision. I have a specialist clinic every Friday.