This review highlights controversies in carotid artery disease guidelines, particularly regarding the timing of intervention after TIA/minor stroke and the treatment of asymptomatic patients.
Year 2011 sees the publication of U.S. guidelines that recommend expanding indications for carotid artery stenting into "average-risk" patients, whereas guidelines from Australia/New Zealand largely do not. This article reviews the status of invasive treatment of carotid disease and highlights 2 controversial issues that were not really addressed in these guidelines: (1) a lack of emphasis on the importance of intervening rapidly after transient ischemic attack/minor stroke; and (2) why continue to recommend that only "highly selected" asymptomatic patients should undergo intervention when virtually no-one pays any attention?
A.R. Naylor (2011) studied this question.