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Review
. 2018 Sep 24;18(11):80.
doi: 10.1007/s11910-018-0888-5.

Asymptomatic Carotid Stenosis: Intervention or Best Medical Therapy?

Kamran Gaba  1   2 , Peter A Ringleb  3 , Alison Halliday  4   5
Affiliations
Review

Asymptomatic Carotid Stenosis: Intervention or Best Medical Therapy?

Kamran Gaba et al. Curr Neurol Neurosci Rep. .

Abstract

Purpose of review: Provide a current overview regarding the optimal strategy for managing patients with asymptomatic carotid artery stenosis.

Recent findings: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) reduce long-term stroke risk in asymptomatic patients. However, CAS is associated with a higher risk of peri-procedural stroke. Improvements in best medical therapy (BMT) have renewed uncertainty regarding the extent to which results from older randomised controlled trials (RCTs) comparing outcomes following carotid intervention can be generalised to modern medical practise. 'Average surgical risk' patients with an asymptomatic carotid artery stenosis of 60-99% and increased risk of late stroke should be considered for either CEA or CAS. In patients deemed 'high risk' for surgery, CAS is indicated. Use of an anti-platelet, anti-hypertensive and statin, with strict glycaemic control, is recommended. Results from ongoing large, multicentre RCTs comparing CEA, CAS and BMT will provide clarity regarding the optimal management of patients with asymptomatic carotid artery stenosis.

Keywords: Asymptomatic; Best medical therapy; Carotid artery stenosis; Carotid artery stenting; Carotid endarterectomy.

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Conflict of interest statement

Conflict of Interest

Kamran Gaba received a grant from the Medical Research Council, during the conduct of the study. Peter Ringleb reports personal fees from Boehringer Ingelheim, personal fees from Bayer and personal fees from Pfizer, outside the submitted work. Alison Halliday declares no potential conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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