Asymptomatic carotid artery procedure

The surgical removal of atheromatous plaque from within the carotid artery is termed carotid endarterectomy. The operation was first performed in an attempt to improve the flow of blood to the brain, although no systematic attempt was made to assess the risks and benefits of the procedure. Subsequently, randomized trials were performed in patients with a history of recent symptomatic stroke, and also in those with asymptomatic disease, to determine whether the operation was beneficial and, if so, what the predictors of benefit would be. As a result of these trials, carotid endarterectomy has been proven to be an effective treatment for the secondary prevention of stroke in selected patients. 

This concern extends to carotid artery stenting. Although carotid artery stenting in patients with asymptomatic CAS can be performed by experienced operators with a low complication rate, the procedure can be associated with high complication rate if performed by inexperienced operators, particularly in older patients with complex anatomy (24). In any case, institution-specific assessment of the risk of carotid intervention, endarterectomy, or stenting should be a prime consideration in clinical decision making regarding carotid revascularization in patients with asymptomatic CAS. 

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