If you are found to have a carotid artery blockage (stenosis), the chances are you can find a doctor who will want to operate or put a stent in to open it up for you, no matter whether you have had symptoms or not.
And, it it true that if you have had a recent TIA or a stroke and have a carotid stenosis, you should consider having surgery as soon as possible to prevent another cerebrovascular event.
However, we have already blogged about how the benefits of having surgery over medical therapy are much lower for patients who are found to have a carotid stenosis on a routine screening study, without ever having had any symptoms, i.e. asymptomatic carotid artery stenosis.
The scientific evidence for avoiding surgery on asymptomatic carotid disease just got a little stronger.
A recent study followed 4319 patients with a history of known arterial disease (coronary heart disease, abdominal aortic aneurysm, or peripheral arterial disease) or risk factors for atherosclerosis (diabetes mellitus, hypertension, and hyperlipidemia), but no previous TIA or stroke. All patients underwent carotid artery doppler, and 293 (about 7%) had a carotid stenosis (>50%). All patients underwent intensive medical management, and were followed for 5-6 years. The risk of stroke was 0.35%/yr overall and 0.4%/yr for patients with carotid stenosis (50-99%), not a statistically significantly difference.
The bottom line here is that if you have carotid stenosis, the first step is to determine if that stenosis is symptomatic or asymptomatic. If there is any doubt about this, you should consult with a stroke expert to be sure. If your carotid stenosis is asymptomatic, it is probably more important to quit smoking, treat blood pressure, treat high blood sugar and treat high cholesterol, and take an anti platelet agent like aspirin, than rush in to getting surgery.