Asymptomatic carotid stenosis: natural history and therapeutic implications

Carotid plaques with different degrees of carotid stenosis are a common condition in the aged population (10% or more after age 75). If the definition of "symptomatic"carotid stenosis (SCS) indicates association with homolateral neurologic hemispheric lesions and/or retinal deficits even in absence of ischemic changes at CT scan, the overwhelming majority of carotid stenoses can be defined asymptomatic (ACS). Considering the low absolute risk of ipsilateral stroke,the additional risk of myocardial infarction, and the perioperative risk, surgery although beneficial in relative terms, should not be applied indiscriminately but rather in selected cases. There is therefore ample space for medical treatments as reduction of risk factors (especially hypertension), antiplatelet drugs, and statins, both in alternative with, as well as before and after surgery.