Asymptomatic carotid disease: changing perspectives.
Information acquired in the last decade has clarified the risk of carotid stenosis and defined multiple causes of stroke. Bruits are associated with very low risk of stroke. Severe stenosis (> 70%) is rare in the general population and only implies a 3%/year stroke risk. Strokes have many causes with as few as 15% due to surgically accessible carotid disease. Studies to date have shown no benefit to prophylactic endarterectomy. Patients with carotid stenosis undergoing surgery have also been shown to be at no significant increased risk. The acceptable risk for surgery on asymptomatic disease is no more than 3%. Whether this can be achieved in the community is unclear. The ideal management of carotid stenosis is unclear. Surgery for asymptomatic disease must be very low risk to be beneficial and, to date, has not been shown to improve the natural history of the problem.
Adams
D S
DS
Tulane University School of Medicine.
D016893:Carotid Stenosis / Q000150:complications / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000209:etiology; D006801:Humans; D012307:Risk Factors