Treatment of asymptomatic carotid artery stenosis

There is much debate about the best approach for treating patients with tight (at least 70%) asymptomatic carotid artery stenosis. A pooled analysis of trials in recently symptomatic patients with carotid artery stenosis showed that successful, uncomplicated surgery or stenting had similar long-term outcomes for at least 8 years, but early post-procedural strokes were more common after stenting than surgery. 1 Brott TG Calvet D Howard G et al. Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: a preplanned pooled analysis of individual patient data. Lancet Neurol. 2019; 18: 348-356 Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar The ACST-2 trial reported that, for asymptomatic patients, both procedures had similar procedural and 5-year follow-up outcomes. 2 Halliday A Bulbulia R Bonati LH et al. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy. Lancet. 2021; 398: 1065-1073 Summary Full Text Full Text PDF PubMed Scopus (47) Google Scholar However, medical treatment for asymptomatic carotid artery stenosis has improved substantially in the past 20 years, when many clinical trials in this population were done, and best medical treatment could now be an option instead of more invasive approaches. Carotid endarterectomy or stenting or best medical treatment alone for moderate-to-severe asymptomatic carotid artery stenosis: 5-year results of a multicentre, randomised controlled trialCEA plus BMT or CAS plus BMT were not found to be superior to BMT alone regarding risk of any stroke or death within 30 days or ipsilateral stroke during the 5-year observation period. Because of the small sample size, results should be interpreted with caution. Full-Text PDF