title: Appropriate Patient Selection for Carotid Revascularization Procedures is Urgently Needed.
abstract: The identification/selection of appropriate patient subgroups with asymptomatic carotid artery stenosis and the performance of prophylactic carotid endarterectomy (CEA)/carotid artery stenting (CAS) exclusively on these asymptomatic patient subgroups is currently one of the "hottest" topics in vascular surgery. It is now clear that offering CEA/CAS to asymptomatic carotid patients based only on the degree of carotid stenosis is unjustified and scientifically flawed. On the other hand, offering only best medical therapy to every asymptomatic patient, irrespective of certain high-risk criteria (such as the detection of microemboli by transcranial Doppler, intraplaque hemorrhage, silent embolic infarcts on brain computed tomography/magnetic resonance imaging, elevated biomarkers, family history), is equally wrong. The validation of specific measures to identify those asymptomatic patients at high risk for developing symptoms is crucial to achieve optimal use of carotid interventions and avoid wasting stroke prevention resources.
authors.affiliation: 1 Northern Vascular Centre, Freeman Hospital, Newcastle Upon Tyne, NHS Foundation Trust, UK.
authors.forename: Kosmas I
authors.initials: KI
authors.lastname: Paraskevas
authors.affiliation: 2 Divisions of Vascular Surgery, New York University Langone Medical Center and Cleveland Clinic, New York, NY and Cleveland, OH, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
authors.affiliation: 3 Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.affiliation: 4 Vascular and Endovascular Clinic, Athens Medical Center, Athens, Greece.
authors.forename: Christos D
authors.initials: CD
authors.lastname: Liapis
mesh_terms: D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D006801:Humans; D018579:Patient Selection; D020521:Stroke / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects
keywords: asymptomatic carotid artery stenosis; best medical therapy; carotid artery stenting; carotid endarterectomy