Asymptomatic carotid artery stenosis: past, present and future. How to improve patient selection?
BACKGROUND
The role of carotid endarterectomy (CEA) for asymptomatic carotid artery stenosis (aCAS) remains a matter of debate. It seems that not only the degree of stenosis, but also other factors have to be taken in account to improve patient selection and increase the benefit of CEA for aCAS.


RESULTS
The literature pertaining aCAS was reviewed in order to describe the natural history, risk of stroke and benefit of CEA for patients with aCAS in regard to several factors.


CONCLUSIONS
The benefit of CEA for aCAS is low. Current factors influencing the indication for CEA are severity of stenosis, age, contralateral disease, stenosis progression to >80%, gender, concomitant operations and life expectancy. To improve patient selection investigations will concentrate on plaque characteristics and instability and cerebral hemodynamics and metabolism.
Rijbroek
A
A
Department of General Surgery, Kennemer Gasthuis, NK-2000 AK Haarlem, The Netherlands. rijbroek@jg.nl
Wisselink
W
W
Vriens
E M
EM
Barkhof
F
F
Lammertsma
A A
AA
Rauwerda
J A
JA
D016893:Carotid Stenosis / Q000150:complications / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D002544:Cerebral Infarction / Q000453:epidemiology; D002560:Cerebrovascular Circulation; D018450:Disease Progression; D016894:Endarterectomy, Carotid; D006801:Humans; D018579:Patient Selection; D015995:Prevalence; D012306:Risk; D020521:Stroke / Q000453:epidemiology