Authors' objectives: Carotid artery stenosis is an important cause of ischemic stroke and is increasingly prevalent from the fifth decade of life onward. Since carotid artery atherosclerosis can largely progress silently and unpredictably, the first manifestation can be a debilitating or fatal stroke. Asymptomatic carotid artery stenosis affects approximately 7 percent of women and over 12 percent of men, older than 70 years of age. Therapeutic options include carotid endarterectomy (CEA) and medical therapy, carotid angioplasty and stenting (CAS) and medical therapy, or medical therapy alone. However, the optimal therapeutic management strategy for patients with asymptomatic carotid stenosis is unclear. The Centers for Medicare and Medicaid Services (CMS) is interested in a systematic review of the literature on these three treatment strategies for patients with asymptomatic carotid stenosis.

Authors' recommendations: The goal of management of asymptomatic carotid stenosis is to decrease the risk of stroke and stroke-related deaths. Our review of therapeutic strategies in patients with asymptomatic carotid stenosis indicates that there has been a significant reduction in the incidence of ipsilateral stroke over time with medical therapy alone. Our subgroup analysis shows that between the year 2000 and 2010, the current best medical therapy can reduce the risk of ipsilateral stroke to nearly 1 percent per year of followup. In addition, use of statins by ≥ 25 percent (vs. < 25 percent) of the study population and use of antiplatelet therapy by ≥ 50 percent (vs. < 50 percent) of the study population was associated with significantly decreased rates of ipsilateral stroke in a few studies that reported this information.

Project Status: Completed

Year Published: 2012

URL for published report: http://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/carotidstenosis/carotidstenosis.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: <p>Agency for Healthcare Research and Quality (AHRQ)</p>