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Carotid Endarterectomy for Asymptomatic Stenosis – Firming Up on the Uncertainty
  1. Charles Warlow
  1. Professor of Medical Neurology, Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU; E-mail: charles.warlow{at}


People with asymptomatic carotid stenosis, which is almost always due to atheroma, are seldom asymptomatic. After all, atheroma is generally a widespread disease – if it affects one artery it probably affects others. So although carotid stenosis may be asymptomatic in the sense that there have been no downstream symptomatic ischaemic events in the brain or eye, the patient will often have had symptoms in the distribution of the contralateral carotid artery, or the vertebrobasilar system, or symptoms of coronary heart or peripheral vascular disease. Sometimes, the so-called asymptomatic carotid artery has in fact been the cause of symptoms, but many months or years previously, so it is not recently symptomatic – the meaning of asymptomatic varies, a point to be watched when reading the literature.

Occasionally an asymptomatic stenosis is picked up by a doctor hearing a bruit in the neck during the course of an examination for some completely unrelated

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