View of current vascular surgery on asymptomatic carotid stenosis

In recent years, the significant progress in the outcomes of conservative treatment for patients with asymptomatic carotid stenosis has sparked discussions about the most effective invasive treatment. The necessity of such treatment is still being debated in certain cases. Several studies have already been conducted to find the most appropriate approach for asymptomatic patients with carotid stenosis, while others are still randomizing and awaiting results. A major unanswered question is whether revascularization is more beneficial than intensive conservative treatment, particularly in view of the lower stroke rates achieved in recent years without conventional or endovascular intervention. The long-term goal should be to identify a subset of patients who would benefit from conservative treatment. In this text, we summarize the issue in the context of the results of two recently completed pivotal studies.