The management of patients with extracranial carotid artery stenosis remains controversial. Randomized controlled studies established the value of carotid endarterectomy (CEA) over optimal medical therapy for patients with symptomatic carotid stenosis. For patients with carotid stenosis, optimal medical therapy includes antiplatelet agents, antihypertensives, and lipid-lowering medications along with lifestyle modifications. Some studies and experts have challenged these treatment methods and consider carotid artery stenting with distal protection as an alternative to CEA. In this article, the authors review current guidelines and supporting studies and suggest practical approaches to this common clinical problem.
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