• Mariana Carreira Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
  • Luís Duarte-Gamas Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
  • João Rocha-Neves Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Biomedicine – Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
  • José Paulo Andrade Department of Biomedicine – Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
  • José Fernando Teixeira Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal



Background: An asymptomatic carotid stenosis (CS) is defined as a stable atherosclerotic luminal narrowing in patients with no history of ipsilateral cerebral or ocular ischemic events in the past six months. The bifurcation of the common carotid artery makes this area vulnerable to atherosclerosis due to the features of haemodynamic flow. The exact prevalence of asymptomatic patients with CS remains unknown and opinions on the treatment of these patients are controversial.

Objective: The authors aimed to review the evidence on the management of the asymptomatic CS and describe its clinical characteristics, diagnosis and treatment management.

Methods: A comprehensive review of the literature was carried out to collate data from relevant studies concerning patients with extracranial moderate to severe asymptomatic carotid stenosis. The data used was identified by a search using PubMed and Google Scholar with the keywords / MESH terms "carotid stenosis", in combination with the term "asymptomatic". For this study, the authors focused on publications in the past two decades, using English publications.

Results: A few studies have addressed the prevalence, natural course and/or prognostic impact of asymptomatic CS in patients under medical treatment or undergoing vascular surgery procedures. The prevalence of asymptomatic CS ranged from 0.3% to 4.5% in women and 0.5% to 5.7% in men - The risk of stroke/TIA in these patients was reported between 2% to 5% annually with a downward trend across time to 0.5% with current best medical therapy.

Conclusion: A great proportion of patients with asymptomatic CS should be submitted to conservative management with best medical therapy. However, selective surgical management should be considered if high risk features are present.


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How to Cite

Carreira M, Duarte-Gamas L, Rocha-Neves J, Andrade JP, Fernando Teixeira J. MANAGEMENT OF THE CAROTID ARTERY STENOSIS IN ASYMPTOMATIC PATIENTS. Rev Port Cir Cardiotorac Vasc [Internet]. 2021 Apr. 17 [cited 2024 May 21];27(3):159-66. Available from:



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