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Management of Patients with an Asymptomatic Carotid Stenosis—Medical Management, Endovascular Treatment, or Carotid Endarterectomy?

  • Stroke (HP Adams, Section Editor)
  • Published:
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Abstract

Patients with asymptomatic carotid stenosis all warrant intensive medical therapy; they are at a higher risk of myocardial infarction than of stroke. With modern intensive medical therapy, the annual risk of ipsilateral is now ∼0.5 %. Justifying carotid intervention on the basis of the results of historic trials with a medical arm, extrapolated to modern trials with lower interventional risks but no medical arm is not legitimate. Most patients (∼90 %) with asymptomatic carotid stenosis would be better served by intensive medical therapy than by either stenting or endarterectomy. The few (∼10 %) who could benefit from intervention can be identified by microemboli on transcranial Doppler and other methods in development. Routine stenting of asymptomatic carotid stenosis, because it is more likely to harm than help the patient, may be considered unethical.

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Authors and Affiliations

  1. Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Road, London, ON, Canada, N6G 2V4

    J. David Spence

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Correspondence to J. David Spence.

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Conflict of Interest

J. David Spence has received grants from the Canadian Institutes for Health Research, the Heart and Stroke Foundation of Canada, NIH/NINDS; lecture honoraria/travel support/consulting fees from Sanofi, Bayer, Merck, Boehringer-Ingelheim; research support for investigator-initiated projects from Pfizer (substantial - donation in kind of eplerenone and matching placebo to support a grant from the Canadian Heart and Stroke Foundation for a clinical trial) and Merck (minor - support for a summer student); over the past 30 years he has performed contract research with many pharma/device companies: all of the above, plus Takeda, BMS, Servier, Wyeth, Miles, Roussel, NMT, AGA, Gore. He is an officer and shareholder of Vascularis Inc. He is a member of the Editorial Boards of Hypertension, Stroke and Arteriosclerosis, Thrombosis and Vascular Biology, and receives royalties on books from Vanderbilt University Press and McGraw-Hill Medical publishers.

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Spence, J.D. Management of Patients with an Asymptomatic Carotid Stenosis—Medical Management, Endovascular Treatment, or Carotid Endarterectomy?. Curr Neurol Neurosci Rep 16, 3 (2016). https://doi.org/10.1007/s11910-015-0605-6

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