Asymptomatic carotid stenosis: what to do.
OBJECTIVE
Patients with asymptomatic carotid stenosis are at increased vascular risk but optimal treatment is controversial. We reviewed the current evidence for medical and surgical intervention in these patients.


RESULTS
Optimal medical treatment is the most important aspect of management of patients with asymptomatic carotid stenosis. On the basis of previous trials, endarterectomy is only of overall benefit in men, and this benefit may now be obviated by improved medical treatment. There is insufficient evidence to advocate the routine use of carotid angioplasty or stenting in patients with asymptomatic stenosis. Inaccuracy in the measurement of carotid stenosis may contribute to conflicting estimates of stroke risk in relation to the degree of asymptomatic stenosis. Advances in noninvasive imaging of plaque morphology and inflammation and the detection of microembolic signals may help to risk stratify patients but data on clinical usefulness are lacking.


CONCLUSIONS
Absolute benefit from endarterectomy for asymptomatic carotid stenosis is small, but can sometimes be justified in men. Further research is required to determine long-term benefit in women and to risk stratify patients, particularly in the light of advances in medical treatment.
Redgrave
Jessica N
JN
Stroke Prevention Research Unit, Department of Clinical Neurology, University of Oxford, UK.
Rothwell
Peter M
PM
D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002339:Carotid Arteries / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D016893:Carotid Stenosis / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D018570:Risk Assessment; D017678:Sex Distribution; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*
D000925:Anticoagulants; D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents