Extra-Cranial Carotid Artery Therapy: Preventing Strokes

A patient-centered approach is reasonable in candidates for carotid revascularization. The patient and their physician should discuss the available treatment options, including revascularization (either carotid artery stenting (CAS) or carotid endarterectomy(CEA)) with their physician. There remains uncertainty regarding the value proposition for revascularization (either CEA orCAS) in asymptomatic patients as a strategy to prevent stroke. Investigation continues into characterizing high-risk carotid plaquesubsets, but until that data is available, physicians and patients should continue to strive to achieve the best outcomes with theinformation that is currently available. The other consideration in asymptomatic patients is that there is a cumulative benefit torevascularization that is dependent on life expectancy. However, the magnitude of the benefit of revascularization, over the longerterm in the setting of multifactorial medical therapy, including statins, is not known.