Advisability of carotid endarterectomy in asymptomatic patients

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OBJECTIVE

To determine the optimal treatment strategy for patients with asymptomatic carotid stenosis.

MATERIAL AND METHODS

The authors reviewed clinical guidelines for the management of patients with asymptomatic carotid stenosis 60—99%, as well as medical studies and meta-analyses comparing carotid endarterectomy and optimal drug therapy in asymptomatic patients between 1993 and 2023.

RESULTS

The choice of treatment strategy for patients with asymptomatic carotid artery stenosis is still a controversial issue. There were several large randomized clinical trials comparing carotid endarterectomy with optimal medical therapy in asymptomatic patients at the end of the 20^th century. However, drug therapy has undergone significant changes calling into question the relevance of previous results. This review highlights the evolution of management of patients with asymptomatic carotid stenosis and also presents modern approaches to the treatment of these patients.

CONCLUSION

Patients younger 75 years old gain an advantage from carotid endarterectomy with small perioperative risk compared to optimal drug therapy and yearly risk of cerebral embolism. Patients with asymptomatic carotid stenosis 80—99% are candidates for carotid endarterectomy due to higher risk of acute cerebrovascular accident at least until more data are available. The choice of the best tactics for a particular patient should be made individually depending on own experience and patient’s adherence to therapy and lifestyle correction. The results of the ACTRIS (2025) and CREST-2 (2026) studies are expected to clarify this issue.

Keywords:

carotid endarterectomy

internal carotid artery stenosis

asymptomatic carotid stenosis

transient ischemic attack

ischemic stroke

optimal drug therapy

Authors:

Korshunov D.A.

Vishnevsky National Medical Research Center for Surgery

ORCID: 0009-0001-8450-2571

Kulbak V.A.

Lomonosov Moscow State University

ORCID: 0000-0001-6743-4012

Chupin A.V.

Russian Medical Academy of Continuing Professional Education

ORCID: 0000-0002-5216-9970

Received:

15.05.2023

Accepted:

01.11.2023

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