Background: Asymptomatic carotid artery stenosis (ACAS), a narrowing of the carotid artery without recent neurological symptoms, is a common manifestation of systemic atherosclerosis and a marker for increased stroke and cardiovascular risk. Its management balances the prevention of future stroke against the risks of intervention. Aim: This review provides an interdisciplinary update on the evaluation and management of ACAS, integrating perspectives from radiological diagnostics, pharmacological optimization, and nursing care coordination to guide evidence-based, patient-centered decision-making. Methods: The synthesis is based on a comprehensive analysis of current guidelines, clinical trials, and cohort studies. It evaluates the roles of various diagnostic imaging modalities (duplex ultrasound, CTA, MRA) for risk stratification and examines the efficacy of best medical therapy (BMT) versus revascularization (CEA, CAS, TCAR). Results: Contemporary BMT, including statins, antiplatelets, and aggressive risk factor control, has significantly reduced the annual ipsilateral stroke risk to approximately 0.9-1%. This diminished baseline risk narrows the net benefit of routine revascularization. Current management therefore prioritizes BMT for most patients, reserving intervention for those with high-risk features such as stenosis progression, plaque vulnerability (e.g., intraplaque hemorrhage), or impaired cerebrovascular reserve. Conclusion: The management of ACAS has evolved towards a personalized, medical-first approach. Interdisciplinary collaboration is essential to identify high-risk patients who may benefit from revascularization while ensuring the majority receive optimized BMT. This strategy, supported by rigorous nursing coordination and advanced radiological diagnostics, optimizes outcomes by minimizing stroke risk and procedural harm.
Alshuhri et al. (2025) studied this question.