The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient's life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.

中文翻译：

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无症状颈动脉狭窄患者的管理可能需要个体化：多学科行动呼吁。

无症状颈动脉狭窄 (ACS) 患者的最佳管理是广泛争论的主题。根据 2017 年欧洲血管外科学会的指南，在存在一种或多种临床 / 情况下，应考虑颈动脉内膜切除术（IIa 类；证据级别：B）或颈动脉支架置入术（IIb 类；证据级别：B）。可能与晚期同侧卒中风险增加相关的影像学特征（例如，脑计算机断层扫描/磁共振成像显示的无症状栓塞性梗死、ACS 严重程度的进展、对侧短暂性脑缺血发作/卒中病史、经颅微栓子检测多普勒等），前提是有记录的围手术期卒中/死亡率<3% 且患者的预期寿命>5 年。除了这些临床/影像学特征外，在有关这些患者的最佳管理的决策过程中可能还应评估其他个人、种族/种族或社会因素，例如患者的个体需求/患者选择、患者对最佳医疗的依从性、患者性别、文化、种族/民族、年龄和合并症，以及成像/手术技术/结果的改进。本多专业立场文件将阐述 ACS 患者管理可能需要个体化的基本原理。患者对最佳医疗的依从性、患者性别、文化、种族/民族、年龄和合并症，以及成像/手术技术/结果的改进。本多专业立场文件将阐述 ACS 患者管理可能需要个体化的基本原理。患者对最佳医疗的依从性、患者性别、文化、种族/民族、年龄和合并症，以及成像/手术技术/结果的改进。本多专业立场文件将阐述 ACS 患者管理可能需要个体化的基本原理。