EDITOR,—We are surprised by the negative attitude of Mark Lambert, who suggests that more than 5000 symptomatic patients with stenosis of >70% each year should be denied the benefit of carotid surgery.1 The efficacy of carotid surgery in symptomatic patients with stenosis of >70% has been proved in both European and Northern American trials.2 3 In addition to giving an inadequate and selective review of the literature, Lambert fails to realise the possible difference in the prevalence of the disease between different communities. For example, he mentions that 40% of patients with a …