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Medical, surgical, and interventional treatment for carotid artery disease
1Department of Neurology, Wayne State University/Detroit Medical Center, Michigan 48201, USA.
Insights
Internal carotid artery atherosclerosis causes ischemic stroke. This review covers antiplatelet therapy, warfarin, carotid endarterectomy, and angioplasty/stenting for stroke prevention in carotid stenosis patients.
Area of Science:
- Neurology
- Vascular Surgery
- Cardiology
Background:
- Internal carotid artery atherosclerosis is a primary cause of ischemic stroke.
- Stroke prevention strategies are crucial for patients with carotid artery stenosis.
Purpose of the Study:
- To review current stroke prevention therapies for carotid stenosis.
- To discuss the roles of medical, surgical, and interventional treatments.
Main Methods:
- Literature review of antiplatelet therapy, warfarin, carotid endarterectomy, and carotid angioplasty/stenting.
- Analysis of treatment decisions based on patient symptomatology and comorbidities.
Main Results:
- Optimal management hinges on whether patients are symptomatic or asymptomatic.
- Coexisting medical conditions significantly impact carotid endarterectomy decisions.
- Current evidence on antiplatelet therapy, warfarin, endarterectomy, and stenting is summarized.
Conclusions:
- Management strategies for carotid stenosis must be individualized.
- The review provides an overview of current therapeutic options for stroke prevention in this patient population.
Abstract:
Internal carotid artery atherosclerosis is a major cause of ischemic stroke. Medical, surgical, and interventional options are available for stroke prevention in patients with carotid artery stenosis. Optimal management of the patient depends to a great degree on whether the individual is symptomatic or asymptomatic. Coexisting medical morbidities also greatly influence treatment decisions regarding carotid endarterectomy. This review highlights the current status of antiplatelet therapy and warfarin for stroke prevention in patients with carotid stenosis. The appropriate role of carotid endarterectomy for symptomatic and asymptomatic patients is also discussed. Finally, the current status of carotid angioplasty and stenting is outlined.