Invasive interventions for asymptomatic stenotic internal carotid artery lesions in paradigm of modern optimal drug therapy

Internal carotid artery ostium is the most common localization of stenotic lesions of extracranial arteries. Stroke in carotid basin usually follows acute occlusion of internal carotid artery as a result of atherosclerotic plaque rupture and vascular thrombosis, ineffective anticoagulation in patients with cardiac arrhythmias. The main purpose of invasive interventions for internal carotid artery stenosis is prevention of postoperative stroke. Currently, two surgical interventions are common: carotid endarterectomy (CEA) and "protected" internal carotid artery stenting (CAS). According to recommendations for the treatment of asymptomatic internal carotid artery stenosis, CEA combined with optimal drug therapy is preferable. However, several large meta-analyses demonstrated comparable long-term mortality and stroke rate for CEA and CAS. The purpose of this report was to highlight the results of large-scale studies comparing efficacy and safety of various surgical treatments with optimal drug therapy in patients with asymptomatic internal carotid artery stenosis receiving modern optimal drug therapy. When choosing any treatment strategy for asymptomatic carotid stenosis, one should pay attention to correction of modifiable risk factors for adverse cardiovascular events, including through optimal drug therapy. Additional studies are needed to stratify specific risk factors of stroke in patients with internal carotid artery stenosis in addition to asymptomatic status.