Aggressive Medical Treatment Evaluation for Asymptomatic Carotid Artery Stenosis

Inclusion Criteria: * Unilateral or bilateral carotid artery stenosis that was considered to be severe (carotid artery diameter reduction 70%-79% on ultrasound) * This stenosis had not caused any stroke, transient cerebral ischaemia, or other relevant neurological symptoms in the past 6 months * Both doctor and patient were substantially uncertain whether to choose immediate CEA, or deferral of any CEA until a more definite need for it was thought to have arisen * The patient had no known circumstance or condition likely to preclude long-term follow-up * Neurologist's explicit consent to potentially perform CEA Exclusion Criteria: * Previous ipsilateral CEA * Expectation of poor surgical risk (e.g., because of recent acute myocardial infarction) * Some probable cardiac source of emboli (because the main stroke risk might then be from cardiac, not carotid, emboli) * Inability to provide informed consent * Underlying disease other than atherosclerosis (inflammatory or autoimmune disease) * Life expectancy \< 6 months * Advanced dementia * Advanced renal failure (serum creatinine \> 2.5 mg/dL) * Unstable severe cardiovascular comorbidities (e.g., unstable angina, heart failure) * Restenosis after prior CAS or CEA * Atrial fibrillation * Allergy or contraindications to study medications (statins, ASA, losartan, amlodipine)