biostudies-literatureEid MASociety for Vascular SurgeryAmerican College of SurgeonsNational Heart, Lung, and Blood InstituteNHLBI NIH HHSNational Institutes of Health2069-2078.e5https://www.ebi.ac.uk/biostudies/studies/S-EPMC12450360biostudies-literatureUnknown82(6)<h4>Objective</h4>The role of prophylactic carotid revascularization in asymptomatic patients aged ≥80 remains controversial. Current guidelines stipulate that asymptomatic older patients at "higher risk of stroke" on best medical therapy may still benefit from carotid intervention. Specifically, there is a widespread perception that a contralateral internal carotid artery (ICA) occlusion may confer an increased anatomical stroke risk, thus creating a surgical dilemma, particularly among older patients. The purpose of this analysis was to determine whether asymptomatic patients aged ≥80 years derive a stroke or survival benefit from prophylactic carotid revascularization in the setting of a contralateral internal carotid artery occlusion.<h4>Methods</h4>We analyzed asymptomatic patients wiJournal of vascular surgerySurgical intervention among asymptomatic patients aged ≥80 with a contralateral carotid occlusion appears selectively warranted.PMC12450360K08 HL165087K08HL165087Neal DHuber TSScali STPerry IStone DHColumbo JAEid MACooper MAUpchurch GRfalseSurgical intervention among asymptomatic patients aged ≥80 with a contralateral carotid occlusion appears selectively warranted.<h4>Objective</h4>The role of prophylactic carotid revascularization in asymptomatic patients aged ≥80 remains controversial. Current guidelines stipulate that asymptomatic older patients at "higher risk of stroke" on best medical therapy may still benefit from carotid intervention. Specifically, there is a widespread perception that a contralateral internal carotid artery (ICA) occlusion may confer an increased anatomical stroke risk, thus creating a surgical dilemma, particularly among older patients. The purpose of this analysis was to determine whether asymptomatic patients aged ≥80 years derive a stroke or survival benefit from prophylactic carotid revascularization in the setting of a contralateral internal carotid artery occlusion.<h4>Methods</h4>We analyzed asymptomatic patients wi2025-01-01T00:00:00Z2025 Dec2026-06-06T13:42:57.216Z2026-05-31T03:09:32.986ZS-EPMC124503604076946210.1016/j.jvs.2025.07.051