A 68-year-old woman is found on carotid duplex to have an 80% asymptomatic right carotid stenosis. She has well-controlled hypertension and no other comorbidities. According to current guidelines based on the ACST and ACAS trials, what is the most appropriate management?
- A Carotid endarterectomy if surgical risk is low and life expectancy exceeds 5 years ✓
- B Carotid artery stenting as first-line over endarterectomy
- C Medical management only, with surgery reserved for symptomatic stenosis
- D Warfarin anticoagulation for stroke prevention
Correct answer: A. Carotid endarterectomy if surgical risk is low and life expectancy exceeds 5 years
Explanation
The ACST and ACAS trials demonstrated that carotid endarterectomy for asymptomatic stenosis greater than 60 to 70% reduces 5-year stroke risk when perioperative risk is below 3% and life expectancy exceeds 5 years. Current guidelines recommend CEA for asymptomatic stenosis of 70 to 99% in such patients. Carotid stenting is reserved for high surgical risk cases.
Reference: Rutherford's Vascular Surgery and Endovascular Therapy, 9th ed.
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