Optimal management of patients with symptomatic and asymptomatic carotid artery stenosis: work in progress

Abstract

The optimal management of patients with symptomatic and asymptomatic carotid artery stenosis remains a subject of extensive debate. Several international societies and associations have published guidelines for the management of carotid patients. Although these recommendations are based on the same randomized trials, differences in interpretation of available knowledge have often led to different (or even conflicting) recommendations. This special report summarizes the current evidence-based optimal management of patients with symptomatic and asymptomatic carotid stenosis and compares key international guidelines. Finally, issues requiring further research are identified and discussed.

Keywords::

• carotid artery stenosis
• carotid artery stenting
• carotid endarterectomy
• stroke
• transient ischemic attack

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The optimal management of patients with symptomatic and asymptomatic carotid stenosis is currently debatable.

• Carotid endarterectomy plus best medical treatment (BMT) comprise the treatment-of-choice for the majority of symptomatic patients, while carotid artery stenting should be reserved for those symptomatic patients at high risk for surgery or in whom surgery is contraindicated.

• All asymptomatic patients should be placed on current BMT.

• For some asymptomatic patients, current BMT alone may not be adequate for stroke prevention.

• Research should aim to identify those asymptomatic patients at high risk for stroke despite current BMT and initiate trials to investigate, if these patients will benefit from an additional carotid revascularization procedure.