Why the study?
The optimal management for patients with asymptomatic carotid artery stenosis remains controversial.
Does carotid revascularization (CEA or stenting) reduce the risk of stroke in patients with carotid artery stenosis compared to medical therapy?
Does carotid revascularization (CEA or stenting) reduce the risk of stroke in patients with carotid artery stenosis compared to medical therapy?
Carotid revascularization provides maximal benefit for stroke prevention in patients with symptomatic CAS ≥70% when performed within 2 weeks of the initial event.
Prompts streamlined urgent pathways for symptomatic high-grade stenosis; leaves open interactions with modern intensive medical therapy.
Carotid Artery Stenosis (CAS) is a marker of systemic atherosclerosis and patients with CAS are at high risk of vascular events in multiple vascular locations, including ipsilateral ischemic stroke. Both medical and surgical therapies have been demonstrated effective in reducing this risk. The optimal management for patients with asymptomatic carotid artery stenosis remains controversial. In patients with symptomatic CAS ≥70%, CEA has been demonstrated to reduce the risk of stroke. With the risk of recurrent stroke being particularly high in the first 2 weeks after the first event, Carotid Endarterectomy (CEA) or carotid angioplasty with stenting provides maximal benefits to patients with symptomatic CAS ≥70% if performed within this «2-week» target. Several large ongoing trials are currently comparing the risks and benefits of carotid revascularization versus medical therapy alone.
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Jusufovic et al. (2019) studied this question.
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