Aspirin in asymptomatic carotid disease

Medical management, particularly antithrombotic treatment with acetylsalicylic acid (ASA) has not been rigorously assessed in the setting of asymptomatic carotid disease. The risk of ischemic vascular events associated with this condition is probably intermediate between the general population and patients who have recently suffered from cerebral ischemic events. Unfortunately, there is a paucity of reliable data regarding the efficacy of any antithrombotic regimen, especially ASA, in the management of this condition. Furthermore, in assessing the potential benefits of long-term use of ASA for prophylactic purposes in these patients, one should also evaluate the side-effects and intolerance related to its chronic use, as well as its potential complications especially from a gastrointestinal perspective. Finally, we present the essential features of the protocol for the Asymptomatic Cervical Bruit Study, which has two objectives: first, to better characterize the natural history of patients with asymptomatic carotid disease and second, to test the efficacy of ASA in the prevention of all types of ischemic events in these patients. It is hoped that the results of this study will provide more reliable data in order that firmer recommendations can be made regarding the use of ASA in asymptomatic carotid disease.