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Carotid endarterectomy is recommended for most symptomatic patients, while asymptomatic patients should receive best medical treatment unless identified as high risk for stroke.
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This commentary reinforces that carotid endarterectomy is the preferred treatment for symptomatic carotid stenosis, while asymptomatic patients should primarily receive best medical therapy unless identified as high-risk for stroke.
This commentary addresses the issue of optimal contemporary management of symptomatic and asymptomatic carotid artery stenosis. Based on current data, carotid endarterectomy (CEA) should be performed in the majority of patients with symptomatic carotid artery stenosis. Carotid artery stenting (CAS) should be reserved for a minority of these symptomatic patients, in whom CEA is contraindicated. In asymptomatic patients, all should be placed on best medical treatment (BMT). With the use of one or more of the proposed stroke risk stratification models or some as yet undetermined method, the identification of those asymptomatic individuals may be possible in whom stroke risk is higher than usual with BMT. This asymptomatic subgroup, which may be small and is yet to be determined with certainty, could be offered an invasive carotid procedure (either CAS or CEA).
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Paraskevas et al. (2011) conducted a review in Symptomatic and asymptomatic carotid artery stenosis. Carotid endarterectomy (CEA) and Carotid artery stenting (CAS) vs. Best medical treatment (BMT) was evaluated. Carotid endarterectomy is recommended for most symptomatic patients, while asymptomatic patients should receive best medical treatment unless identified as high risk for stroke.
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