En la estenosis carotídea asintomática, salvo excepciones, el tratamiento médico es el más adecuado

Asymptomatic carotid stenosis (ACS) has a high prevalence and a small possibility of stroke. Its treatment involves the application of the so-called, intensive medical treatment (IMT) of the arteriosclerosis, and in selected cases, carotid surgery, either by endarterectomy (TEA) or a Stent (CAS). The current indications are based on old clinical trials in which the current medical treatment was not applied, and the only selection criterion relating to the lesion was the grade of stenosis. With the application of IMT, the stroke rate in patients with ACS is currently similar to that obtained in the surgical arm of the clinical trials, results that are better than in normal practice. If there is a sub-group of patients who could benefit from surgery, then they are those with an unstable plaque despite the IMT. For all this, we should be cautious when performing a surgical intervention in patients with ACS. Randomised clinical trials are needed to compare CAS, TEA, and the improved medical treatment in patients with ACS.