Why the study?
The optimal management of patients with asymptomatic carotid stenosis is extensively debated, with multiple clinical, imaging, and individual factors influencing treatment decisions.
Management of asymptomatic carotid stenosis should be individualized based on a combination of clinical, imaging, and patient-specific socio-demographic factors.
Supports individualized risk assessment in ACS; leaves open whether specific imaging features should guide revascularization.
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient's life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.
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Paraskevas et al. (2021) conducted a review in Asymptomatic Carotid Stenosis. Individualized management (CEA, CAS, or BMT) was evaluated. The management of patients with asymptomatic carotid stenosis should be individualized based on patient preference, sex, ethnicity, age, comorbidities, and adherence to medical therapy.
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