Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action

The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject extensive debate. According to 2017 European Society for Vascular Surgery guidelines, endarterectomy should (Class IIa; Level Evidence: B) or artery stenting may be considered IIb; in presence one more clinical/imaging characteristics that associated an increased risk late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression severity ACS, a history contralateral transient ischemic attack/stroke, microemboli detection transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and patient’s life expectancy >5 years. Besides these characteristics, there additional individual, ethnic/racial social factors probably evaluated decision process regarding patients, such as individual patient needs/patient choice, compliance best medical treatment, sex, culture, race/ethnicity, age comorbidities, well improvements imaging/operative techniques/outcomes. present multispecialty position paper will rationale why ACS need individualized.