Management of asymptomatic carotid stenosis

Neurol Clin. 2015 May;33(2):443-57. doi: 10.1016/j.ncl.2014.12.008.


With modern intensive medical therapy, the risk of ipsilateral stroke in patients with asymptomatic carotid stenosis (ACS) is below the risk of either carotid stenting or endarterectomy. Routine intervention for ACS is therefore not justified; approximately 90% of patients with ACS would be better off with intensive medical therapy. The few who could benefit can be identified by transcranial Doppler embolus detection or features of vulnerable plaque that can be imaged by 3-dimensional ultrasound, MRI or positron emission tomography/computed tomography; some of these methods are still in development.

Keywords: Asymptomatic; Carotid stenosis; Endarterectomy; Medical therapy; Microemboli; Stenting; Transcranial Doppler.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anticholesteremic Agents / therapeutic use
  • Antihypertensive Agents / therapeutic use
  • Carotid Stenosis / drug therapy*
  • Carotid Stenosis / surgery
  • Endarterectomy, Carotid
  • Ezetimibe / therapeutic use
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Platelet Aggregation Inhibitors / therapeutic use


  • Anticholesteremic Agents
  • Antihypertensive Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors
  • Ezetimibe