The aim of carotid endarterectomy (CEA) is to prevent stroke by removal of the internal carotid artery (ICA) stenosis. The efficacy of carotid endarterectomy in symptomatic patients is well documented.
However, the efficacy of CEA in asymptomatic patients, especially in elderly and women, is subject of intense debate. An approach to increase the benefit from carotid surgery in asymptomatic patients is to identify those who live long enough to outweigh the perioperative risks. As myocardial infarction is responsible for up to 50 % of perioperative deaths and thus, causes more postoperative deaths than strokes, a prediction of cardiovascular and thus overall mortality by a biomarker would help to identify these patients. A potential candidate for risk stratification in carotid surgery is the amino acid homocysteine, which is a widely acknowledged risk factor for cardiovascular adverse events in both genders.