Carotid endarterectomy (CEA) remains one of the most effective surgical interventions for prevention of recurrent stroke in appropriately selected patients with extracranial carotid atherosclerotic disease. Its role is particularly important after a recent transient ischaemic attack (TIA) or nondisabling ischaemic stroke caused by ipsilateral carotid stenosis. Contemporary international guidelines generally favour CEA over transfemoral carotid artery stenting (CAS) in standard-risk symptomatic patients with ≥50%
stenosis, with the greatest benefit in severe symptomatic disease and when treatment is delivered promptly. In asymptomatic disease, the balance has become more nuanced because modern medical therapy has lowered baseline stroke risk and the absolute benefit of prophylactic intervention is smaller. Hong Kong presents a distinctive clinical context. Cerebrovascular disease remains a major cause of death and hospital utilisation, while historical local studies describe a relatively high burden of intracranial atherosclerotic disease among Chinese patients. This may complicate attribution of neurological symptoms to extracranial carotid stenosis and reinforces the need for comprehensive cerebrovascular imaging and multidisciplinary decision-making. Local CEA series, although relatively small and historically concentrated in tertiary centres, have demonstrated acceptable perioperative outcomes and durable stroke-prevention benefit. This narrative review synthesises evidence from major randomised trials, contemporary guidelines, and Hong Kong-specific literature to provide a practical framework for CEA in Hong Kong. Key issues include diagnostic confirmation, selection of symptomatic and asymptomatic patients, timing after TIA or stroke, CEA versus CAS, perioperative medical therapy, anaesthetic and surgical considerations, complications, postoperative surveillance,
and research priorities. The review argues that Hong Kong should preserve CEA as a core component
of stroke prevention while strengthening rapid-access pathways, prospective outcome registries,
multidisciplinary selection, and locally relevant comparative-effectiveness research.
carotid endarterectomy; carotid stenosis; carotid artery stenting; stroke prevention; transient ischaemic attack;
Hong Kong