Optimal management of patients with asymptomatic carotid artery stenosis remains unclear. Although 2 high-quality randomized clinical trials demonstrated reductions in ispsilateral stroke rates in patients without symptoms after carotid endarterectomy, medical therapy of asymptomatic carotid artery stenosis has reduced rates of stroke to approximately 1% per year, raising questions about the generalizability of these previous trials to current medical practice. However, reductions in adverse events after revascularization can make revascularization more attractive. The emergence of percutaneous revascularization for carotid artery stenosis has raised further questions about optimal management of asymptomatic carotid artery stenosis. This Grand Rounds summarizes the factors to consider when counseling patients and making clinical decisions regarding medical therapy and revascularization for patients with asymptomatic carotid artery stenosis. This information should provide clinicians with the knowledge base to counsel patients about the risks and benefits of treatment options.
Doppler ultrasound of the right internal carotid artery demonstrates a peak systolic velocity of 496 cm/s (normal reference range, <125 cm/s) and end diastolic velocity of 207 cm/s (normal reference range, <40 cm/s). Based on the Consensus Criteria,1 significant elevations in both the systolic and diastolic velocity suggest a severe stenosis of 70% to 99%, closer to 99%.
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