COMMENTARY

Asymptomatic Patients With CAS: To Intervene or Not?

Frank J. Veith, MD

Disclosures

September 18, 2013

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In This Article

The Treatment of Carotid Disease: A Controversial Topic

I am Frank Veith, Professor of Surgery at NYU Medical School and the Cleveland Clinic. This morning I am going to provide an update on a very interesting and controversial topic: the treatment of carotid disease in the neck to prevent stroke. I should start out by saying that there are several interesting points about this that will underlie all of my remarks. Number one, this is a very controversial area. Number two, statin drugs and other medical treatments -- but particularly statins -- have made an enormous difference in the underlying disease (arterial sclerosis) and made it less threatening and less dangerous in many ways. The third point is that we are talking about disease in the neck, but the purpose of treatment is not to make the disease in the neck look better but to prevent stroke. Only about 20%-30% of all strokes come from carotid disease in the neck that is amenable to treatment. The fourth point is that there is enormous literature on this, and underlying much of the literature is the bias of the people who are writing the article. Naturally, all of us who do treatments are biased toward our treatments, and that must be kept in mind when reviewing any of the literature.

So, what is new with carotid treatment in the neck? It is important to divide symptomatic carotid disease from asymptomatic carotid disease because the two are quite different in their behavior, natural history, and so forth. When I say "symptomatic carotid disease," I mean really symptomatic carotid disease that produces strokes or amaurosis fugax. It doesn't include patients with headache, dizziness, or other nonspecific symptoms.

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