The current strategic management of asymptomatic carotid stenosis


  • Songkram Chotik-anuchit Division of Neurology. Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok


Asymptomatic carotid stenosis, Carotid endarterectomy, Carotid stent, Unstable plaque, High risks plaque


Asymptomatic carotid stenosis has been enormously debated, especially in the aspect of ischemic neurological prevention. The better efficacy of antiplatelets and lipid lowering agents may be enough for prevention of stroke. Patient with high risk plaque have the greater risk of stroke than usual. The characters of high risk plaque such as rapidly progressive stenosis, larger plaque area, large lipid core, thin fibrous cap and the evidence of distal embolization should be elucidated in all patient with carotid stenosis
Carotid endarterectomy (CEA) or carotid stenting (CAS) are currently suitable treatment in asymptomatic carotid stenosis of >60-70%. Although, the CEA had the lower risk of perioperative complications, but the higher risk of postoperative myocardial infarction. Therefore, the CAS may be alternative treatment especially in the patient who had high risk of perioperative complication from CEA.
Despite of the many issues concerned for strategic planning of stroke prevention. Comprehensive discussion between physician and patient are also the crucial complementary strategy for stroke prevention therapy.


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How to Cite

Chotik-anuchit S. The current strategic management of asymptomatic carotid stenosis. J Thai Stroke Soc [Internet]. 2024 Apr. 10 [cited 2024 Jun. 19];23(1):22. Available from:



Review article