" Endarterectomy Combined With Optimal Medical Therapy (OMT) vs OMT Alone in Patients With Asymptomatic Severe Atherosclerotic Carotid Artery Stenosis at Higher-than-average Risk of Ipsilateral Stroke "

Inclusion Criteria: * Age 50 years or over * No ipsilateral stroke or TIA within 180 days of randomization * Atherosclerotic carotid stenosis between 70 and 99% (NASCET method) * At least one of the following markers of ipsilateral stroke risk: * Silent brain infarction on MRI, DWi, consistent with embolism from or hemodynamic consequences of the qualifyiing stenosis * History of contralateral TIA or ischemic stroke due to atherosclerotic carotid disease * Predominantly echolucent plaque on ultrasound * Rapid (within 1 year) carotid stenosis progresion * TCD-detected microembolic signals * Impairment of TCD-measured cerebral vasomotor reserve * Intraplaque haemorrhage on magnetic resonance imaging * Rapid and severe stenosis progression * Patient is able and willing to give informed consent Exclusion Criteria: * Previous revascularization procedure in the artery to be randomised * Patients not suitable for endarterectomy due to anatomical factors * Carotid stenosis caused by non-atherosclerotic disease e.g. neck radiotherapy or fibromuscular disease * Patients who have had contralateral carotid artery or vertebral artery or intracranial artery revascularisation within 6 weeks prior to randomisation * Patients with planned revascularisation of the contralateral carotid artery or a vertebral artery or an intracranial artery within 6 weeks after randomisation or the date of CEA * Patients who have had coronary artery bypass grafting within 3 months prior to r…