An arteriogram of a 75-year-old man is shown below. He have an asymptomatic carotid bruit. The patient has mild hypertension and mild COPD. The current recommendation for this man would be
Medical therapy with aspirin 325 mg/day and medical risk factor management
Medical therapy with warfarin
Angioplasty of the carotid lesion followed by carotid endarterectomy if the angioplasty is unsuccessful
Carotid endarterectomy
In a recent prospective, randomized, multicenter trial involving 1662 patients in a study known as the Asymptomatic Carotid Atherosclerosis Study, patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter and whose general health made them good candidates for elective surgery were found to have a significant reduction in the 5-year risk for ipsilateral stroke with surgery compared with medically treated cohorts (5.1 vs. 11.0%). Medically treated patients were treated with aspirin on a daily basis. Warfarin has not been shown to be effective in the management of patients with carotid disease. Angioplasty of carotid stenoses is being performed in some institutions on a purely investigational basis and to date has not replaced surgery as the treatment for high-grade carotid stenoses.
Arterial Disorders