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Perioperative Medical Management for Symptomatic Carotid Artery Interventions

  • Cerebrovascular Disease and Stroke (S Silverman, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of this review is to provide the reader with an overview of symptomatic carotid stenosis and the approach to medical management of patients undergoing surgical intervention with both carotid endarterectomy (CEA) and carotid artery stenting (CAS).

Recent Findings

CEA is recommended for patients with moderate to severe symptomatic carotid stenosis and transient ischemic attack (TIA) or non-disabling stroke. More recently CAS has also been shown to be a beneficial, less invasive option for patients with symptomatic carotid stenosis. All patients need urgent medical therapy to reduce the risk of stroke before, during, and after surgical intervention. These therapies have traditionally included single anti-platelet and/or anticoagulation therapy. More recent studies have demonstrated the benefit of dual antiplatelet therapy (DAPT) and lipid-lowering medications, specifically statins.

Summary

Patients with symptomatic carotid stenosis who are undergoing CEA or CAS must also be placed on the appropriate medical therapy during this time. General guidelines exist regarding the approach to medical management; however, largely due to the lack of modern randomized clinical trials, the specific management approach likely varies between institutions.

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    Rachel Forman MD & Scott Silverman MD

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Forman, R., Silverman, S. Perioperative Medical Management for Symptomatic Carotid Artery Interventions. Curr Treat Options Cardio Med 24, 171–182 (2022). https://doi.org/10.1007/s11936-022-00966-1

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