Management of asymptomatic carotid artery stenosis

Opinion statement: Patients with atherosclerotic asymptomatic carotid artery disease are at a heightened risk of major adverse cardiovascular events including ischemic stroke. Intensive risk factor modification, including lifestyle interventions and the use of evidence based medical therapies, reduces the risk of adverse cardiovascular events in this population. Carefully selected patients with severe asymptomatic carotid stenosis may benefit from carotid endarterectomy or stenting. Patient and lesion characteristics may help to carefully select patients most likely to benefit from revascularization. Emerging therapies, including novel lipid lowering therapies, anti-platelet therapies, and anti-coagulant therapies, may further reduce the risk of adverse cardiovascular events in patients with stable atherosclerotic disease. The most important aspect of the management of asymptomatic carotid artery stenosis is reducing the overall cardiovascular risk of the patient.