Symptomatic and asymptomatic carotid stenosis: how, when, and who to treat?

Carotid stenosis is an important cause of ischemic stroke. Large randomized trials of endarterectomy have shown that surgery reduces the risk of stroke in patients with recently symptomatic carotid stenosis of 50% or greater, and to a lesser extent in patients with asymptomatic carotid stenosis of 60% or greater. More recent research has gone some way in identifying which patients benefit most and when intervention is most effective. Individual risk modeling has been shown to be useful in selecting patients with the most to gain from endarterectomy for symptomatic stenosis, although timely surgery and optimal medical treatment are of equal importance. Further research is required in order to determine the role of carotid stenting and to identify those individuals with asymptomatic stenosis who have the most to gain from intervention.