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Update on Surgical Management for Asymptomatic Carotid Stenosis

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Abstract

The management of asymptomatic carotid stenosis has been a topic of considerable debate. In this article, we aim to critically review the recent literature as it pertains to surgical management of asymptomatic carotid stenosis. We will explore the most recent trials looking at advancements in best medical therapy, as well as trials that compare traditional carotid endarterectomy to carotid stenting. In addition, we will review the current literature on surgical technique and perioperative risk management. Overall, our current recommendation is for surgical management of asymptomatic carotid disease for stenoses ≥ 80% in patients who are of reasonable perioperative risk.

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Abbreviations

ACAS:

Asymptomatic Carotid Atherosclerosis Study

ACES:

Asymptomatic Carotid Emboli Study

ACST:

Asymptomatic Carotid Surgery Trial

CREST:

Carotid Revascularization Endarterectomy Versus Stenting Trial

GALA:

General Anesthesia Versus Local Anesthesia for Carotid Surgery

SAPPHIRE:

Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy

SPACE-2:

Stent-protected Angioplasty in Asymptomatic Carotid Artery Stenosis Versus Endarterectomy

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Division of Vascular Surgery, 5 East 98th Street, 4th Floor, Box 1273, New York, NY, 10029, USA

    Margaret H. Walkup & Peter L. Faries

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  1. Margaret H. Walkup
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  2. Peter L. Faries
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Correspondence to Peter L. Faries.

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Walkup, M.H., Faries, P.L. Update on Surgical Management for Asymptomatic Carotid Stenosis. Curr Cardiol Rep 13, 24–29 (2011). https://doi.org/10.1007/s11886-010-0146-1

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