There have been contradictions regarding the optimal treatment of patients with asymptomatic
severe internal carotid artery stenosis (ACAS). From the one hand previous studies
proved benefit from carotid intervention in ACAS patients, from the other hand due
to the development of modern medical therapy there has been a significant reduction
in stroke incidence in patients with only medical treatment. Recent calculations have
suggested that the stroke risk with intensive medical therapy is lower or similar
compared with that of carotid endarterectomy or carotid artery stenting in ACAS patients.
Therefore, carotid reconstruction for the most patients with asymptomatic severe internal
carotid artery stenosis has not been suggested recently. However, some special subgroups
with high stroke risk were shown to benefit from carotid surgery. High-risk patients
are characterised by poor collateral circulation with exhausted cerebrovascular reserve
capacity, or by unstable plaque with cerebral microembolisation. The present article
summarizes the use of transcranial Doppler in selection of high-risk ACAS patients
who may benefit from carotid intervention.