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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

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Asymptomatic Carotid Stenosis: Intervention or Best Medical Therapy?

Kamran Gaba1,2, Peter A Ringleb3, Alison Halliday4,5

  • 1Nuffield Department of Population Health, Medical Research Council Population Health Research Unit, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK. kamran.gaba@ndph.ox.ac.uk.

Current Neurology and Neuroscience Reports
|September 26, 2018
PubMed

Insights

Optimal management for asymptomatic carotid artery stenosis involves considering carotid endarterectomy (CEA) or carotid artery stenting (CAS) based on surgical risk. Best medical therapy (BMT) is crucial for all patients.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Cardiology

Background:

  • Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established interventions to reduce stroke risk in asymptomatic carotid artery stenosis.
  • Recent advancements in best medical therapy (BMT) necessitate re-evaluation of established treatment guidelines.
  • Carotid artery stenting (CAS) carries a higher risk of peri-procedural stroke compared to CEA.

Purpose of the Study:

  • To provide an updated overview on the optimal management strategies for patients diagnosed with asymptomatic carotid artery stenosis.
  • To discuss the evolving role of medical therapy in conjunction with interventional procedures.

Main Methods:

  • Review of recent randomized controlled trials (RCTs) and clinical practice guidelines.
  • Comparative analysis of outcomes between CEA, CAS, and BMT.
  • Assessment of patient risk stratification for surgical intervention.

Main Results:

  • For 'average surgical risk' patients with 60-99% stenosis and high stroke risk, both CEA and CAS are viable options.
  • CAS is the recommended intervention for patients classified as 'high risk' for surgery.
  • Comprehensive BMT, including antiplatelets, antihypertensives, statins, and strict glycemic control, is universally recommended.

Conclusions:

  • The choice between CEA and CAS depends on individual patient risk factors and surgical expertise.
  • Ongoing large-scale RCTs comparing CEA, CAS, and BMT are expected to further refine optimal management strategies.
  • Aggressive medical management remains a cornerstone in the care of patients with asymptomatic carotid artery stenosis.
Abstract

Keywords:
AsymptomaticBest medical therapyCarotid artery stenosisCarotid artery stentingCarotid endarterectomy

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