Carotid revascularization - New insights and state of the debate

Carotid artery stenosis increases the risk of ischemic stroke. Accordingly, intensive investigation of methods used to diagnose, screen, treat, and monitor patients with carotid artery stenosis have led to advancements in the field. However, despite voluminous literature as well as significant strides in the management of patients with carotid artery stenosis, some ambiguities remain. In fact, recent major society guidelines have provided inconsistent, and sometimes conflicting, recommendations regarding specific topics on the management of carotid artery stenosis. Here we review five such topics that have recently been contested in the literature: 1) screening for carotid artery stenosis; 2) management of asymptomatic carotid artery stenosis; 3) role of CAS in management of symptomatic carotid artery stenosis; 4) timing of carotid revascularization in symptomatic patients; and 5) concurrent carotid and coronary artery revascularization.