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The past two decades has been characterized by important advances in symptomatic care to the muscular patient. In particular, the development of home mechanical ventilation was associated by a substantial improvement in life expectancy. The presence of a muscular disease is less frequently a contra-indication of surgery and subsequently the issue of anesthetizing these patients has become a routine question. A growing number of muscular disorders have been subjected to specific guidelines for anesthetic procedures.

There has not been a peripheral vascular surgical procedure subject to as exquisite scruting as carotid endarterectomy. The last decade gave a new attitude after the analysis and conclusions of the North American Symptomatic Carotid Endarterectomy Symptomatic extracranial lesions were best managed with operative intervention rather than antiplatelet treatment alone. Now, in the first decade of the new millenium, we are embarking on yet another test of carotid endarterectmy--a comparison with percutaneous angioplasty and stenting, which is a most rigorous contest because endarterectomy must now withstand comparison with another "active treatment" rather than the more passive observational modality of antiplatelet therapy. The topic of the authors was to provide a panorama of the contemporay treatment of carotid disease at this pivotal point in the life cycle carotid endarterectomy.