Revascularization of Asymptomatic High-Grade Carotid Stenosis Is Still Indicated in Some Cases

The Case:A 61 year-old man with an asymptomatic ICA stenosis (ACS) greater than 80%. The Questions: The Controversy:Revascularization of asymptomatic high-grade carotid stenosis is still indicated despite contemporary stroke prevention medical therapy.Up to 20% of ischemic stroke is caused by carotid artery disease. Robust evidence shows that operating for symptomatic carotid stenosis prevents stroke if performed early after the ischemic event, but the majority of strokes due to carotid stenosis are not preceded by minor stroke or transient ischemic attack. One approach to preventing stroke in this group of patients is to operate before symptoms occur, that is, on asymptomatic carotid stenosis (ACS).Results from 2 large well-conducted randomized controlled trials have shown that carotid …