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Abstract
Asymptomatic extracranial internal carotid artery atherosclerotic stenosis increases with age and is more common in men. Studies performed more than 2 decades ago showed that carotid endarterectomy reduced the rate of stroke in carefully selected patients with asymptomatic carotid stenosis compared with medical therapy in the long term. Those trials were completed more than 20 years ago and with advances in the treatment of atherosclerotic disease, the question has been raised to as to whether endarterectomy is still of value for patients with asymptomatic narrowing. Perioperative risk of carotid revascularization procedures has also declined. Due to improvements in both medical and surgical treatments for carotid artery stenosis, it is timely to reevaluate the efficacy of carotid intervention relative to medical treatment for patients with asymptomatic stenosis.
GLOSSARY
- ACAS=
- Asymptomatic Carotid Atherosclerosis Study;
- ACST=
- Asymptomatic Carotid Surgery Trial;
- AMM=
- aggressive medical management;
- CAS=
- carotid artery stenting;
- CEA=
- carotid endarterectomy;
- CREST=
- Carotid Revascularization Endarterectomy versus Stenting Trial;
- CREST 2=
- Carotid Revascularization and Aggressive Medical Management Trial;
- ECST 2=
- European Carotid Surgery Trial 2;
- ICA=
- internal carotid artery;
- MMSE=
- Mini-Mental State Examination;
- PAD=
- peripheral artery disease;
- SAMMPRIS=
- Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis;
- SPARCL=
- Stroke Prevention by Aggressive Reduction in Cholesterol Levels
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received April 28, 2016.
- Accepted in final form August 10, 2016.
- © 2016 American Academy of Neurology
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