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Management of Asymptomatic Carotid Artery Stenosis

Current Treatment Options in Cardiovascular Medicine volume 21, Article number: 80 (2019) Cite this article

Abstract

Purpose of review

The goal of this paper is to provide the reader with a review of the evidence supporting the surgical and medical management of patients with asymptomatic internal carotid artery (ICA) stenosis.

Recent findings

Based on the results of earlier clinical trials, surgical intervention with carotid endarterectomy (CEA) has long been the preferred method of management for patients with asymptomatic severe carotid stenosis. Carotid artery stenting (CAS) is another less invasive surgical option that has similar outcomes over the long-term. However, more recent improvements in medical management have reduced the risk of stroke in this population to comparable rates seen with CEA. As a result, medical management alone is advocated as well for patients with asymptomatic carotid stenosis. In addition to stenosis severity, there are a number of features of plaque morphology associated with vulnerable plaque that predict future stroke risk.

Summary

Rates of stroke in patients with asymptomatic severe carotid stenosis with modern surgical techniques, CEA and CAS, are similar to modern medical therapy alone. Both surgery and medical therapy are good treatment options but it is not known which treatment is superior. The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2), an NIH-sponsored, multicenter, randomized trial that aims to answer this important management decision.

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    Scott Silverman MD

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Silverman, S. Management of Asymptomatic Carotid Artery Stenosis. Curr Treat Options Cardio Med 21, 80 (2019). https://doi.org/10.1007/s11936-019-0796-2

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Keywords

  • Asymptomatic carotid stenosis
  • Carotid endarterectomy
  • Carotid artery stenting
  • Modern medical management