Asymptomatic Carotid Stenosis

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Abstract
Management of the asymptomatic stenosis of the carotid bifurcation remains an unsettled question in the care of patients with generalized atherosclerosis. The natural history of the untreated condition is not known. Available data on the subject are mostly retrospective, ill-defined, and recommendations range from careful observation to aggressive surgical intervention. There are not enough data to support either posture. Whether the available information is reliable and accurate in predicting the stroke risk of the hemodynamically significant carotid lesions remains the main issue in this controversy. Recently, a cooperative group of Veterans Administration Hospitals embarked on a prospectively randomized study comparing surgical vs medical therapy for patients with significant asymptomatic carotid artery lesions. Until their results are available, therapy must be based on current data. In this article we review this information and attempt to provide guidelines in the management of these patients. PATIENTS AND METHODS Definition of Problem Permanent neurologic