biostudies-literatureUnknown8(19)Fernandes E Fernandes JManagement of asymptomatic carotid disease continues to challenge medical practice and present evidence is often conflicting. Stroke is a significant burden in Public Health and 11% to 15% appear as first neurologic event associated with asymptomatic carotid stenosis. Randomized trials provided support for Guidelines and Recommendations to intervene on asymptomatic stenosis, but at a known cost of a high number of unnecessary operations. Conflicting evidence from natural history studies and the widespread use of proper medical management including risk factors control, lowering-lipid drugs and strict control of arterial hypertension have reduced the incidence of strokes associated to asymptomatic carotid disease challenging established practice. Need to identify vulnerable lesions prone toAnnals of translational medicine1279https://www.ebi.ac.uk/biostudies/studies/S-EPMC7607137biostudies-literatureThe conundrum of asymptomatic carotid stenosis-determinants of decision and evidence.PMC7607137Goncalves IMendes Pedro LFernandes E Fernandes JfalseThe conundrum of asymptomatic carotid stenosis-determinants of decision and evidence.Management of asymptomatic carotid disease continues to challenge medical practice and present evidence is often conflicting. Stroke is a significant burden in Public Health and 11% to 15% appear as first neurologic event associated with asymptomatic carotid stenosis. Randomized trials provided support for Guidelines and Recommendations to intervene on asymptomatic stenosis, but at a known cost of a high number of unnecessary operations. Conflicting evidence from natural history studies and the widespread use of proper medical management including risk factors control, lowering-lipid drugs and strict control of arterial hypertension have reduced the incidence of strokes associated to asymptomatic carotid disease challenging established practice. Need to identify vulnerable lesions prone to2020-01-01T00:00:00Z2020 Oct2025-04-26T20:49:18.861Z2025-04-06T16:32:38.37ZS-EPMC76071373317881110.21037/atm-2020-cass-12