There is mandate for intervention for asymptomatic carotid disease

Stroke is the third leading cause of death and the first, among cardiovascular diseases, most frequent cause of disability, demanding elevated social costs and needing huge resources to address assistance and rehabilitation. The prevention of stroke has consequently become of utmost importance in modern health care. Some 30 years after the introduction on large scale of carotid endarterectomy (CEA) for the prevention of neurological disturbances from carotid bifurcation plaques, and more than 10 years since the publication of international prospective randomized studies that seemed to finally allay doubts and uncertainties on the subject, transmitting for posterity the message that CEA is the gold standard for the prevention of stroke, some old problems concerning indication and appropriateness of CEA remain unsolved and some new ones have appeared preponderantly on the international scene. While there is a substantial consensus that CEA is effective in the prevention of stroke in symptomatic patients with haemodynamic carotid artery stenoses, Trials have concluded that the evidence of benefit of CEA in asymptomatic patients with a 70% or more carotid stenosis is questionable and in many cases minimal, compared with conservative medical treatment. These data conflict with the diffuse practice worldwide of CEA procedures performed on asymptomatic patients and also with the conclusion of other equally influential and authoritative publications. The position of these authors, that effective prevention of stroke should also be addressed to asymptomatic carotid stenoses, is justified by data from the literature showing that only a minority of strokes is preceded by transient neurological symptoms or ischemic attack.