Evaluation and management of asymptomatic carotid artery stenosis

David William Dodick, Irene Meissner, Fredric B. Meyer, Harry J. Cloft

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Internal carotid artery stenosis (ICAS) is responsible for approximately 30% ischemic strokes. Internal carotid artery stenosis of greater than 50% is present in about 4% to 8% of the population aged 50 to 79 years. Natural history studies and clinical trials have shown a small increase in stroke risk in patients with increasing degrees of ICAS, especially in those with greater than 80% reduction in carotid artery diameter. Randomized, prospective multicenter trials have revealed the superiority of carotid endarterectomy (CEA) over medical therapy in recently symptomatic patients with severe ICAS. However, the evidence from several randomized controlled trials of CEA in asymptomatic patients does not support the use of CEA in most of these patients; also, the role of noninvasive screening in this patient population remains uncertain and controversial. Furthermore, there Is considerable uncertainty about whether the statistical benefit of avoiding a nondisabling stroke is worth the overall cost and risk of the procedure. Clinicians continue to struggle with treatment decisions for patients with asymptomatic ICAS. Carotid endarterectomy for asymptomatic ICAS should be considered only for medically stable patients with 80% or greater stenosis who are expected to live at least 5 years, and only in centers with surgeons who have a demonstrated low (<3%) perioperative complication rate. We outline the prevalence and natural history of ICAS, the evidence for CEA in patients with asymptomatic ICAS, the roles of screening and monitoring for ICAS, the methods of evaluating ICAS, and the implications for practicing clinicians.

Original languageEnglish (US)
Pages (from-to)937-944
Number of pages8
JournalMayo Clinic Proceedings
Volume79
Issue number7
StatePublished - 2004

Fingerprint

Carotid Stenosis
Carotid Endarterectomy
Stroke
Natural History
Carotid Arteries
Population
Multicenter Studies
Uncertainty
Pathologic Constriction
Randomized Controlled Trials
Clinical Trials
Costs and Cost Analysis

Keywords

  • ACAS = Asymptomatic Carotid Atherosclerosis Study
  • ACST = Asymptomatic Carotid Surgery Trial
  • ARR = absolute risk reduction
  • CE = contrast-enhanced
  • CEA = carotid endarterectomy
  • Cl = confidence interval
  • CTA = computed tomographic angiography

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Evaluation and management of asymptomatic carotid artery stenosis. / Dodick, David William; Meissner, Irene; Meyer, Fredric B.; Cloft, Harry J.

In: Mayo Clinic Proceedings, Vol. 79, No. 7, 2004, p. 937-944.

Research output: Contribution to journalArticle

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