Carotid endarterectomy may be required in addition to best medical treatment for some patient subgroups with asymptomatic carotid stenosis.
Several guidelines recommend carotid endarterectomy for patients with severe asymptomatic carotid stenosis to reduce the risk of a future cerebrovascular event, as long as the perioperative stroke/death rate is <3%. Based on improvements in best medical treatment, it was argued that currently best medical treatment alone should comprise the treatment-of-choice for asymptomatic carotid stenosis patients and that no intervention is warranted in these individuals. While it is true that best medical treatment should be used for the management of all asymptomatic carotid stenosis patients, emerging evidence suggests that best medical treatment alone may not prevent disease progression and the development of symptoms in some asymptomatic carotid stenosis patient subgroups. This article analyzes the results of two recent independent studies demonstrating that medical therapy alone may not be adequate for stroke prevention in some asymptomatic carotid stenosis patient subgroups. These results suggest that besides best medical treatment, additional carotid endarterectomy should be considered for specific asymptomatic carotid stenosis patients.
Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK paraskevask@hotmail.com.
Kosmas I
KI
Paraskevas
St. George's London/Nicosia University Medical School, University of Nicosia, Cyprus.
Andrew N
AN
Nicolaides
Divisions of Vascular Surgery, New York University Langone Medical Center and The Cleveland Clinic, New York and Cleveland, USA.
Frank J
FJ
Veith
D058070:Asymptomatic Diseases; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D018450:Disease Progression; D016894:Endarterectomy, Carotid; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents
Asymptomatic carotid artery stenosis; best medical treatment; carotid endarterectomy; stroke