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The question of whether patients with asymptomatic carotid stenosis benefit from surgery appears to be resolved -- the final results from the Asymptomatic Carotid Atherosclerosis Study (ACAS) confirm the preliminary findings announced last year -- these patients do benefit from endarterectomy. The prospective, randomized multicenter trial conducted at 39 sites in the U.S. and Canada assigned 1662 patients with stenoses of 60 percent or more and no symptoms to receive medical therapy with aspirin or carotid endarterectomy, and followed them for a median of 2.7 years. During the perioperative period, 2.3 percent of patients assigned to surgery had a stroke or died. More than one quarter of these complications were directly due to cerebral ang…