Introduction

Somewhere between 15 and 20% of patients presenting with transient ischemic attack (TIA) or non-disabling ischemic stroke have a significant stenosis at or around the bifurcation of the ipsilateral carotid artery and about 5-10% of asymptomatic elderly individuals have significant stenosis of at least one carotid artery. The purpose of this book is to summarize current knowledge about the natural history and optimal treatment of patients with carotid disease and to consider future directions for research and therapy. However, it is appropriate to first briefly review how our current understanding and practice have developed. The recent history of the development of medical treatments for vascular disease is well known and so we have confined ourselves to a brief review of the history of our understanding of the role of carotid stenosis in causing TIA and stroke, and of the development of surgical and endovascular treatment.