Management of symptomatic carotid disease in 2014.

Extracranial carotid artery stenosis accounts for up to 12 % of stroke, the third leading cause of death in industrialized nations. Carotid stenoses leading to transient or permanent neurologic or retinal symptoms within the preceding 6 months are deemed symptomatic and require prompt noninvasive evaluation and treatment. Preventive medical therapy is standard for symptomatic carotid stenosis and continues to evolve. Landmark trials have proven carotid endarterectomy (CEA) superior to medical therapy for stroke prevention in symptomatic lesions. Modern investigations have proven carotid artery stenting (CAS) non-inferior to CEA, and the strength of the combined data has led to a class I recommendation for CEA or CAS in patients with high grade symptomatic carotid stenosis, provided the risk of perioperative events is acceptable. Evidence-based modern management of symptomatic carotid stenosis is reviewed here.