Carotid Revascularization Decision Tree

Key Notes:

Contralateral occlusion and significant contralateral stenosis (≥50–70%) are high-risk features.
High-grade ipsilateral stenosis: ≥70% (NASCET).
Symptomatic timing: after 48 h but within 14 days for maximum benefit.
CREST-2: CAS + IMM showed benefit vs medical therapy; CEA did not reach significance.
CREST-H: no cognitive benefit from revascularization in asymptomatic stenosis.
Always continue intensive medical therapy.