“Optimal management of patients with asymptomatic carotid artery stenosis remains unclear. Although 2 high quality clinical trials demonstrated reductions in stroke rates in patients without symptoms after carotid endarterectomy, medical therapy of asymptomatic carotid artery stenosis has reduced rates of stroke to approximately 1% per year, raising questions about generalizability of these previous trials to current medical practice. However, reductions in adverse events after revascularization can make revascularization more attractive. The emergence of percutaneous revascularization for arotid artery stenosis has raised further questions about optimal management of asymptomatic carotid artery stenosis. This Grand Rounds summarizes the factors to consider when counseling patients and making clinical decisions regarding medical therapy and revascularization for patients with asymptomatic carotid artery stenosis. This information should provide clinicians with the knowledge base to counsel patients about the risks and benefits of treatment options. (JAMA, Oct 16) Click here to read full text.