Key result
CAE for asymptomatic internal carotid stenosis remains controversial until natural history is better understood.
Why the study?
Does carotid artery endarterectomy benefit patients with asymptomatic internal carotid artery stenosis?
Does carotid artery endarterectomy benefit patients with asymptomatic internal carotid artery stenosis?
The benefit of carotid endarterectomy for asymptomatic carotid stenosis remains controversial and requires further understanding of the disease's natural history.
Answers are grounded in this paper and cite their sources.
Caution advised against routine endarterectomy in asymptomatic stenosis; leaves open the need for natural history data to inform guidelines.
SUMMARY The recent European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) have clearly defined a population who benefit from carotid artery endarterectomy (CAE). However these trials used different criteria to identify >70% stenosis of the internal carotid artery (ICA). The role of CAE in asymptomatic ICA stenosis has been investigated by the Carotid Artery Stenosis with Asymptomatic Narrowing Operation Versus Aspirin (CASANOVA) study, the Veterans Administration Asymptomatic Carotid Study (VAACS) and the Asymptomatic Carotid Artery Stenosis (ACAS) trials, all of which have design limitations. The Asymptomatic Carotid Stenosis Trial (ACST) is still recruiting patients but until the natural history of asymptomatic ICA disease is understood, the role of surgical intervention will continue to be controversial.
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Panayiotopoulos et al. (1996) conducted a review in Asymptomatic carotid artery stenosis. Carotid artery endarterectomy was evaluated. Carotid artery endarterectomy for asymptomatic internal carotid artery stenosis remains controversial until the natural history of the disease is better understood.
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