A 68-year-old man with a transient ischemic attack affecting the right hemisphere undergoes carotid Doppler which reveals 70% stenosis of the left internal carotid artery by NASCET criteria. What is the recommended management?

• A Extracranial-intracranial bypass surgery
• B Carotid artery stenting only
• C Best medical therapy alone
• D Carotid endarterectomy within 2 weeks ✓

Explanation

The NASCET trial demonstrated significant benefit of carotid endarterectomy for symptomatic stenosis of 70-99%. Surgery is recommended within 2 weeks of the index event for symptomatic patients with ≥50-69% stenosis and clearly for ≥70% stenosis. Best medical therapy alone is reserved for surgical candidates with <50% stenosis or high surgical risk. Stenting is an alternative for select patients.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.