Management of asymptomatic carotid stenosis

With modern intensive medical therapy, the risk of ipsilateral stroke in patients with asymptomatic carotid stenosis (ACS) is below the risk of either carotid stenting or endarterectomy. Routine intervention for ACS is therefore not justified; approximately 90% of patients with ACS would be better off with intensive medical therapy. The few who could benefit can be identified by transcranial Doppler embolus detection or features of vulnerable plaque that can be imaged by 3-dimensional ultrasound, MRI or positron emission tomography/computed tomography; some of these methods are still in development.