[Asymptomatic carotid lesions]

The appropriate management of cases of asymptomatic stenosis of the carotid artery is still very much a matter of controversy. There are those who decline intervention of any kind since they argue that patients exhibiting such a syndrome are particularly exposed to the general complications of atheroma, and essentially to myocardial infarction. At present, when additional tests are available which allow the severity of the stenosis to be assessed, this attitude does not seem logical since patients with a severe or very severe stenosis run a serious risk of TIA and CVA. This view emerges from a number of recent studies, some of which are prospective and confirm the gravity of the spontaneous progression of a severe stenosis of the internal carotid artery. Moreover, study of the statistics shows that, after intervention, mortality lies at about 1 percent with a morbidity of less than 3 percent. Thus, if it is out of the question to suggest prophylactic intervention for all patients exhibiting an asymptomatic stenosis of the carotid artery, such an intervention should be considered in the case of severe stenosis, equal to or higher than 70 percent.