Management of asymptomatic carotid atherosclerosis.

The detection, evaluation, and treatment of patients with asymptomatic carotid artery disease are controversial issues. In this review, these issues are addressed and the appropriate application of medical and surgical therapies is discussed. There seem to be two subgroups of asymptomatic patients with angiographically defined lesions (marked stenosis or large, deep, and compound ulcers) who have a significant risk of subsequent cerebral infarction. These patients should be considered for carotid endarterectomy at a surgical center with an established low incidence of perioperative complications.