Asymptomatic carotid stenosis: identifying patients for revascularization

The best treatment for patients with asymptomatic carotid stenosis is a rather debated topic and there is significant discrepancy in the indication for surgical revascularization therapy either across different centers and countries or between guidelines. The purpose of this narrative review is to try to provide the tools for a multidisciplinary approach in order to best stratify the patient. Current evidence supports the hypothesis that only a small proportion of patients can benefit from surgical treatment, but they should be identified and managed in the optimal way to ensure the best option for preventing ischemic stroke. Current evidence regarding optimal medical therapy, which should be guaranteed to all patients with carotid stenosis, will also be briefly discussed.