Asymptomatic carotid stenosis: what to do.

Abstract:

PURPOSE OF REVIEW:Patients with asymptomatic carotid stenosis are at increased vascular risk but optimal treatment is controversial. We reviewed the current evidence for medical and surgical intervention in these patients. RECENT FINDINGS:Optimal medical treatment is the most important aspect of management of patients with asymptomatic carotid stenosis. On the basis of previous trials, endarterectomy is only of overall benefit in men, and this benefit may now be obviated by improved medical treatment. There is insufficient evidence to advocate the routine use of carotid angioplasty or stenting in patients with asymptomatic stenosis. Inaccuracy in the measurement of carotid stenosis may contribute to conflicting estimates of stroke risk in relation to the degree of asymptomatic stenosis. Advances in noninvasive imaging of plaque morphology and inflammation and the detection of microembolic signals may help to risk stratify patients but data on clinical usefulness are lacking. SUMMARY:Absolute benefit from endarterectomy for asymptomatic carotid stenosis is small, but can sometimes be justified in men. Further research is required to determine long-term benefit in women and to risk stratify patients, particularly in the light of advances in medical treatment.

journal_name

Curr Opin Neurol

authors

Redgrave JN,Rothwell PM

doi

10.1097/WCO.0b013e328012da60

subject

Has Abstract

pub_date

2007-02-01 00:00:00

pages

58-64

issue

1

eissn

1350-7540

issn

1473-6551

pii

00019052-200702000-00011

journal_volume

20

pub_type

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