The proper management of carotid stenosis remains an important and controversial area in vascular surgery. Recent studies have led to some degree of consensus on surgical treatment of symptomatic stenosis, but a number of questions remain about the management of asymptomatic patients. This review summarizes the existing data about the natural history of carotid stenosis. Of particular importance are the results of recent large clinical trials, including the asymptomatic carotid atherosclerosis trial (ACAS). The review examines the available data as well as the reasons for continued controversy The author also describes his current approach to the treatment of asymptomatic carotid disease.
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