Effectiveness of carotid endarterectomy for asymptomatic carotid stenosis in the statins era

The benefit of carotid endarterectomy in asymptomatic patients is currently questioned, due to an observed reduction in stroke rate with current medical treatment. A review is carried out on the available evidence. The perioperative use of statins, better standardisation of surgical techniques, concentration of endarterectomy by surgeons with a higher surgical volume, and identification of high-risk patients, have led to a parallel decrease in post-endarterectomy stroke. An asymptomatic subpopulation has been identified with an increased risk of developing neurological events: severe carotid stenosis, rapid progression of stenosis, presence of silent hemispherical infarcts, micro-emboli in transcranial doppler, lower cerebrovascular reserve, and unstable plaques. The future of carotid endarterectomy in asymptomatic patients lies in the identification of lesions with increased risk of stroke and performing surgery with minimal morbidity and mortality. Imaging studies have rapidly progress, but better validation is required before changing current management guidelines. (C) 2016 SEACV. Published by Elsevier Espana, S.L.U. All rights reserved.