Current management of asymptomatic carotid occlusive disease: a review

Cerebrovascular disease is a major cause of morbidity and disability worldwide, placing a large financial burden on health care systems. The majority of strokes are ischemic in nature. A significant portion these result from occlusive disease of the extracranial carotid artery. Treatment of asymptomatic patients identified with significant carotid artery disease is aimed at the prevention of stroke and its resultant morbidity. To this end, carotid endarterectomy has been established as the gold standard by several landmark trials. Carotid angioplasty and stenting, on the other hand, has been introduced as a minimally invasive alternative for these patients. However, the indications for its use in this patient population continue to be in flux as data from large controlled studies emerges. The purpose of this manuscript is to review current data regarding the use of both carotid angioplasty and stenting and endarterectomy as treatments for asymptomatic carotid occlusive disease.