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Medical Therapy for Carotid and Vertebral Artery Stenosis

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Extracranial Carotid and Vertebral Artery Disease

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Abstract

All patients with evidence of internal carotid artery or vertebral artery atherosclerotic disease should be treated with medical therapy to stabilize and hopefully prevent the progression of the atherosclerotic disease process. In practice, this includes several facets. This includes antithrombotic therapies to prevent thrombus formation and the subsequent risk of transient ischemic attack or ischemic stroke. In addition, cholesterol lowering with statin medication is recommended to help prevent disease progression. Blood pressure control is also important to retard ongoing vascular injury. Lifestyle modification such as smoking cessation and increased physical activity is also recommended.

In this chapter, we shall outline the rationale and evidence for these therapies in patients with carotid atherosclerosis. In addition, modern clinical trials that are testing aggressive medical management for carotid artery stenosis will be discussed.

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Abbreviations

CHANCE:

Clopidogrel in High-Risk Patients With Acute Nondisabling Events

CREST-2:

Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Study

ECST:

European Carotid Surgery Trial

EPOCH-CAS:

Effect of pitavastatin on preventing ischemic complications with carotid artery stenting

ESPRIT:

European/Australasian Stroke Prevention in Reversible Ischemia Trial

ESPS2:

European Stroke Prevention Study 2

LIPID:

Long-term Intervention with Pravastatin in Ischemic Disease

mRS:

Modified Rankin Scale

NASCET:

North American Symptomatic Carotid Endarterectomy Trial

NIHSS:

National Institutes of Health Stroke Scale

PRoFESS:

Prevention Regimen for Effectively Avoiding Second Strokes

SAMMPRIS:

Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis

SMART:

Second Manifestations of ARTerial disease

SOCRATES:

Acute Stroke or Transient Ischemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes

SPARCL:

Stroke Prevention by Aggressive Reduction in Cholesterol Levels

VISSIT:

Vitesse Stent Ischemic Therapy

WASID:

Warfarin-Aspirin for Symptomatic Intracranial Disease

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Author information

Authors and Affiliations

  1. Vascular Neurology, University of Miami Miller School of Medicine, Miami, FL, USA

    Moayd M. Alkhalifah & Paul M. Gadient

  2. Vice-Chair for VA Programs, University of Miami Miller School of Medicine, Miami, FL, USA

    Seemant Chaturvedi

Authors
  1. Moayd M. Alkhalifah
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  2. Paul M. Gadient
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  3. Seemant Chaturvedi
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Corresponding author

Correspondence to Seemant Chaturvedi .

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Editors and Affiliations

  1. Wayne State University School of Medicine, Detroit, MI, USA

    Sachinder Singh Hans

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Alkhalifah, M.M., Gadient, P.M., Chaturvedi, S. (2018). Medical Therapy for Carotid and Vertebral Artery Stenosis. In: Hans, S. (eds) Extracranial Carotid and Vertebral Artery Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-91533-3_9

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  • DOI: https://doi.org/10.1007/978-3-319-91533-3_9

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-91533-3

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