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Aspirin
33%
3/9
Bilateral carotid endarterectomy
0%
0/9
Left carotid endarterectomy only
56%
5/9
Observation
Warfarin
11%
1/9
Select Answer to see Preferred Response
This patient is presenting with a transient ischemic attack and carotid artery occlusion < 60%; thus, the best next step in management is daily aspirin. Carotid stenosis can lead to neurologic sequelae such as a transient ischemic attack. If carotid stenosis is < 60%, then the best next step in management is antiplatelet agents such as aspirin. Indications for carotid endarterectomy include symptomatic patients with 60-99% stenosis. Patients with stenosis > 60% who cannot undergo a surgical procedure can also be managed medically with antiplatelet agents. Generally, all of these patients will be started on aspirin at some point in their care. Incorrect Answers: Answers 2-3: Endarterectomy is only indicated if stenosis is > 60%. This patient's stenosis in each carotid artery is < 60% warranting medical management. Answer 4: Observation is not appropriate management of symptomatic carotid stenosis < 60%. This patient should be started on antiplatelet therapy with aspirin as the preferred first-line agent. Answer 5: Warfarin is the preferred management for atrial fibrillation as long-term anticoagulation. Bullet Summary: Carotid stenosis < 60% is best managed with antiplatelet therapy (aspirin); whereas, symptomatic patients with stenosis > 60% are best managed with carotid endarterectomy.
4.1
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