Therapy of carotid arteriosclerosis

Carotid arteriosclerotic disease is the most readily treatable type of lesion leading to stroke. Its management involves lowering those risk factors over which the patient has control. Patients should regulate hypertension, quit smoking, seek medical attention for treatable cardiac abnormalities, and take steps to reduce increased blood lipids. For symptomatic carotid disease, regardless of whether surgery is offered, platelet inhibitors are obligatory. The recommended dose is 650 mg aspirin per day (or up to 1300 mg, if tolerated). For patients whose symptoms continue despite aspirin therapy or who are aspirin intolerant, ticlopidine is the only recommended platelet inhibitor. Cerebral arterial bypass surgery is not an effective treatment for carotid arteriosclerosis. Carotid endarterectomy helps patients with > or = 70% stenosis as determined by strict arteriographic measurements. We do not yet have sufficient data to determine whether endarterectomy would benefit patients with lower levels of carotid stenosis or asymptomatic patients with any degree of stenosis.