Management of Asymptomatic Carotid Stenosis

Guideline Recommendations

• The European Society of Cardiology recommends against routine revascularization in asymptomatic patients with internal carotid artery stenosis in the absence of high-risk features and with a life expectancy <5 years 1
• The American Heart Association suggests that carotid endarterectomy (CEA) may be reasonable in asymptomatic patients with >70% stenosis if the risk of perioperative stroke, MI, and death is low (<3%), but its effectiveness compared with contemporary medical management is not well established 2, 3
• The American Heart Association and American Stroke Association state that prophylactic carotid artery stenting (CAS) might be considered in highly selected patients with asymptomatic carotid stenosis, but its effectiveness compared with medical therapy alone is not well established 2, 3

Patient Management

• The American Stroke Association recommends optimal medical therapy including antiplatelet therapy and statins as the cornerstone of management for asymptomatic carotid stenosis 3
• The European Society of Cardiology explicitly states that in asymptomatic patients with ICA stenosis, in the absence of high-risk features and with a life expectancy <5 years, routine revascularization is not recommended (Class III, Level A) 1

Surveillance and Follow-up

• The American College of Radiology recommends regular surveillance with duplex ultrasound to monitor progression of stenosis 2, 5
• The American College of Radiology suggests reassessing for development of symptoms or progression of stenosis that might warrant intervention in the future 5