A 64-year-old man who suffered a nondisabling right hemisphere ischaemic stroke 3 months ago remains on aspirin and a statin. Duplex sonography shows 75 percent stenosis of the right internal carotid artery at the origin. He has no other comorbidity. What is the most appropriate additional intervention?
- A Continue medical therapy alone and repeat duplex yearly
- B Carotid artery stenting as first choice regardless of age
- C Carotid endarterectomy if performed as soon as feasible ✓
- D Extracranial-intracranial bypass surgery
Correct answer: C. Carotid endarterectomy if performed as soon as feasible
Explanation
The North American Symptomatic Carotid Endarterectomy Trial showed that symptomatic patients with 70 to 99 percent ipsilateral stenosis gain a large absolute risk reduction from endarterectomy added to best medical therapy, with maximum benefit when surgery is done early, ideally within two weeks of the event. Stenting carries higher periprocedural stroke risk and is reserved for selected patients such as those with hostile neck anatomy. ECST measures residual rather than distal lumen, giving different percentages for the same lesion.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.