What to do with the Asymptomatic Carotid Stenosis?

12th Biennial Meeting of the International Andreas Gruentzig Society:  Rio de Janeiro - February 2-6, 2014

From SESSION 3 — Endovascular

Moderator:  Tyrone Collins
Panelists:  Robert Bersin , Dieter Liermann, Klaus Mathias, Sigrid Nikol, Souheil Saddekni, Jiri Vitek, Jim Zidar

Framing the question at hand, what is the state of the current knowledge?
Therapy for carotid artery stenosis includes medical therapy, endovascular and surgical therapy.  Treatment in all cases is prophylactic. There may be patients who are classified as asymptomatic, however, they may exhibit evidence of subclinical strokes by imaging studies. Composition of carotid plaque may vary significantly from patient to patient. The nature of the plaque has an impact on clinical outcome and need for intervention.

What are the Gaps in the current knowledge?
Different treatment modalities and different follow-up periods make it hard to compare treatment approaches. Plaque assessment to classify which lesion should be treated is not well defined.  The degree of stenosis and patient age in the asymptomatic patient, especially the elderly patient, make clinical decisions about intervention less clear.  There is also debate over how much screening should be performed to identify carotid artery disease in asymptomatic patients.

Our Summary and Recommendations:
Remembering that this is preventative therapy in an asymptomatic population with variable risk of a clinical ischemic event, the risk of treatment must be very low. We support ongoing studies evaluating and stratifying carotid plaques and imaging studies to identify asymptomatic cerebral involvement. Support of randomized trials and registries should continue to expand our knowledge base.  We should continue to lobby for reimbursement for endovascular therapy and for physician and patient choice.