Impaired Cerebral Vasoreactivity and Risk of Stroke in Patients With Asymptomatic Carotid Artery Stenosis

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Abstract
The management of patients with asymptomatic carotid artery stenosis is one of the most controversial topics in the cerebrovascular disease literature. The results of the Asymptomatic Carotid Atherosclerosis Study (ACAS)1 showed a reduction of the risk of stroke in patients undergoing endarterectomy compared with those treated medically. However, the actual benefit of carotid endarterectomy in asymptomatic patients, in terms of prevention of annual disabling stroke vs the risk of angiography and surgery, may not justify its introduction into routine clinical practice.2 The benefit of surgery could be significantly increased in a subgroup of patients with a high predisposition to develop cerebrovascular events. However, defining a high-risk patient with severe asymptomatic carotid stenosis remains difficult. Selecting patients for surgery based on their age, progression of lesion, morphologic characteristics, and degree of carotid stenosis and concomitant risk factors is apparently acceptable,3(pp1506-1507) but to date, there is no evidence of any factor that may influence the prognosis of patients with asymptomatic carotid stenosis.4

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