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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 31 OF 100
A right-handed, 75-year-old man presents with an acute left-sided corona radiata ischemic stroke. Workup, including carotid ultrasound, reveals <50% stenosis in the right internal carotid artery, and 70% to 99% stenosis in the left internal carotid artery at the bifurcation. Which of the following is the most appropriate management strategy?
A. Revascularization of the right carotid artery with a carotid stent
B. Revascularization of the right carotid artery with carotid endarterectomy
C. Medical management with aspirin and a high-dose statin only **
D. Revascularization of the left carotid artery with carotid artery stent or endarterectomy in 6 months
E. Medical management with aspirin and a high-dose statin, and consideration of revascularization of the left internal carotid artery within 4 weeks
** = Your answer
The North American Symptomatic Carotid Endarterectomy Trial (NASCET) reported that carotid endarterectomy provided a substantial benefit for patients with ≥70% symptomatic stenosis. Two-year ipsilateral stroke risk was 26% in patients treated with medication and 9% patients treated with carotid endarterectomy (P < 0.001). Recent evidence suggests revascularization within 2 weeks is recommended, as stroke risk remains highest within the first few weeks after the initial event.
* Moneta GL, Edwards JM, Chitwood RW, et al. Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning. J Vasc Surg. 1993 Jan;17(1):152-159