Evolving treatment strategies for carotid artery stenosis

Internal carotid artery stenosis is an important cause of ischemic stroke. Treatment decisions frequently center on whether the patient is symptomatic or asymptomatic. For recently symptomatic patients with severe stenosis (70% to 99%) and low to medium surgical risk, carotid endarterectomy (CEA) is extremely useful for stroke prevention. CEA is moderately useful for patients with 50% to 69% symptomatic stenosis and is not indicated for patients with symptomatic stenosis of less than 50%. CEA may be useful for select patients with severe asymptomatic stenosis (80% to 99%) but only if the surgical complication is kept below the 3% level. Carotid stenting is an emerging option for the future but is still experimental. In addition to carotid intervention, patients with carotid stenosis should receive aggressive risk factor management, including treatment with antiplatelet agents and statins.