Evidence-based treatment of symptomatic and asymptomatic arteriosclerotic carotid artery stenosis

Stroke is still the most frequent disease leading to permanent disability in industrialized countries, so that an effective primary and secondary prevention is of considerable importance. Of the approximately 250,000 stroke cases that occur in Germany each year around 80% are cerebral ischemia. Approximately 15% of these cases of ischemia are caused by lesions of the extracranial internal carotid artery (ICA). The optimal treatment of high-grade asymptomatic arteriosclerotic carotid artery stenosis is still the subject of controversial debate as intensified drug treatment (best medical treatment, BMT) has led to a significant reduction in risk. For example, the risk of a carotid-associated cerebral infarction with a > 50% asymptomatic stenosis of the ICA is only approximately 1%. This review article presents the current evidence-based treatment of symptomatic and asymptomatic high-grade carotid artery stenosis, focusing on the presentation of current study data and recommendations for the treatment of asymptomatic ICA stenosis.