Optimal management of patients with asymptomatic carotid stenosis

Prior trials have shown that carotid endarterectomy (CEA) is superior to nonoperative management of asymptomatic carotid stenosis.1,2 More recent trials have shown surprisingly better outcomes for stroke patients managed with maximal medical therapy.3,4 As such, a number of experts have called for revisiting clinical trials of both CEA and carotid stenting for patients with symptomatic and asymptomatic carotid stenosis using modern medical therapy. Given the current substantial equipoise within the field, modern studies seem reasonable. A number of ongoing trials aim to address current areas of equipoise, but enrollment in these studies has been slow.