Asymptomatic carotid artery disease in the elderly. Diagnosis and management strategies

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• Carotid atherosclerosis is frequently found in asymptomatic elderly individuals and those with existing vascular disease.
• Carotid bruits are unreliable indicators of asymptomatic carotid stenosis.
• Asymptomatic carotid stenosis is detected via ultrasound or angiography.

Purpose of the Study:

• To review the current understanding and management of asymptomatic carotid stenosis.
• To discuss the risks associated with asymptomatic carotid stenosis.
• To evaluate the controversial treatment options for asymptomatic carotid stenosis.

Main Methods:

• Literature review of studies on carotid atherosclerosis and stenosis.
• Analysis of risk factors and outcomes in patients with asymptomatic carotid stenosis.
• Discussion of current treatment modalities, including antiplatelet agents and surgical endarterectomy.

Main Results:

• The annual risk of ipsilateral infarction in asymptomatic carotid stenosis is approximately 1% to 2%, often presenting as transient ischemic attacks.
• Stroke risk increases with progressive stenosis, stenosis greater than 75%–80%, and complex plaque morphology.
• The efficacy and complication rates of carotid endarterectomy for asymptomatic stenosis are still under investigation.

Conclusions:

• The management of asymptomatic carotid stenosis remains controversial.
• Antiplatelet agents have not demonstrated proven value in asymptomatic patients.
• Endarterectomy may be withheld for asymptomatic patients with stenosis less than 75%–80% pending further trial results. Prophylactic endarterectomy is not indicated for asymptomatic stenosis in patients undergoing other major surgeries like coronary artery bypass.