Risk stratification of patients with asymptomatic carotid artery stenosis: Demographic and clinical considerations

Several prospective randomized clinical trials have established that medical therapy combined with carotid endarterectomy (CEA) is superior to medical therapy alone in treatment of patients with asymptomatic carotid artery stenosis (CAS).1-3 However, there remains significant discord among individual physicians as to how to select patients with asymptomatic CAS who stand to gain the most from carotid revascularization in terms of stroke prevention and have the least procedural complications. When physicians encounter patients with asymptomatic CAS, they typically have access to a limited set of clinical information as well as carotid imaging data - ultrasound or magnetic resonance angiography/computed tomographic angiography (MRA/CTA). The purpose of this chapter is to review the relevant demographic and clinical data that need to be considered in the process of clinical decision-making regarding carotid revascularization in patients with asymptomatic CAS.