Management of patients with asymptomatic carotid stenosis may need to be individualized: A multidisciplinary call for action

Kosmas I. Paraskevas, Dimitri P. Mikhailidis, Hediyeh Baradaran, Alun H. Davies, Hans Henning Eckstein, Gianluca Faggioli, Jose Fernandes E Fernandes, Ajay Gupta, Mateja K. Jezovnik, Stavros K. Kakkos, Niki Katsiki, M. Eline Kooi, Gaetano Lanza, Christos D. Liapis, Ian M. Loftus, Antoine Millon, Andrew N. Nicolaides, Pavel Poredos, Rodolfo Pini, Jean Baptiste RiccoTatjana Rundek, Luca Saba, Francesco Spinelli, Francesco Stilo, Sherif Sultan, Clark J. Zeebregts, Seemant Chaturvedi

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject oextensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotiendarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considere(Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics thamay 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.

Original languageEnglish (US)
Pages (from-to)202-212
Number of pages11
JournalJournal of Stroke
Issue number2
StatePublished - 2021
Externally publishedYes


  • Carotid stenosis
  • Endarterectomy, carotid
  • Ischemic attack, transient
  • Life expec-tancy
  • Patient preference
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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