Unnecessary carotid surgery for asymptomatic atheroma

"Pending the completion of CREST-2, we think that it would be desirable for interventionists and surgeons to forgo stenting and endarterectomy in low-risk asymptomatic patients outside that trial. This restraint would not only spare patients from procedures that may be unnecessary, but it should also facilitate early completion of the trial (and so avoid the fate of SPACE-2), so that it may be possible to identify which patients will benefit from an intervention rather than medical therapy alone in an evidence-based rather than an eminence-based manner."

http://www.ncbi.nlm.nih.gov/pubmed/26890473

The only advice is: take a second advice!

"Evidence now suggests that the annual rate of ipsilateral stroke may be as low as 0.5 to 1%8 — a rate that is very similar to that observed in ACT I and CREST after successful stenting or endarterectomy."

The other issue about carotid plaque is to assess the status of the plaque surface. For instance in ACS a small trial is testing DAPT instead of stents:
http://www.medscape.com/viewarticle/868367?src=wnl_tp10n_161007_mscpedit_ous&uac=7267HX&impID=1210486

https://clinicaltrials.gov/show/NCT02041650?link_type=CLINTRIALGOV&access_num=NCT02041650