Risks of Asymptomatic Carotid Stenosis May Be Higher than Previously Thought

The benefits of revascularization are less certain for asymptomatic carotid stenosis than for symptomatic stenosis, because the natural history risks are lower to begin with and recent advances in medical therapy may push these risks even lower. We have been limited to using the degree of carotid stenosis as our main, rather blunt predictor of risk, leaving other potentially high-risk features related to the characteristics of the plaque itself to speculation and debate. To address this gap, investigators estimated the prevalence of putative high-risk plaque features and the overall incidence of ipsilateral ischemic events associated with asymptomatic carotid stenosis from the published literature, comprised of 64 observational studies that…