Medical Therapy for Carotid and Vertebral Artery Stenosis

  • Moayd M. Alkhalifah
  • Paul M. Gadient
  • Seemant ChaturvediEmail author


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.


Carotid stenosis Atherosclerosis Hypertension Aspirin Antiplatelet therapy Statins Hyperlipidemia 



Clopidogrel in High-Risk Patients With Acute Nondisabling Events


Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Study


European Carotid Surgery Trial


Effect of pitavastatin on preventing ischemic complications with carotid artery stenting


European/Australasian Stroke Prevention in Reversible Ischemia Trial


European Stroke Prevention Study 2


Long-term Intervention with Pravastatin in Ischemic Disease


Modified Rankin Scale


North American Symptomatic Carotid Endarterectomy Trial


National Institutes of Health Stroke Scale


Prevention Regimen for Effectively Avoiding Second Strokes


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


Second Manifestations of ARTerial disease


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


Stroke Prevention by Aggressive Reduction in Cholesterol Levels


Vitesse Stent Ischemic Therapy


Warfarin-Aspirin for Symptomatic Intracranial Disease


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Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Moayd M. Alkhalifah
    • 1
  • Paul M. Gadient
    • 1
  • Seemant Chaturvedi
    • 2
    Email author
  1. 1.Vascular NeurologyUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Vice-Chair for VA ProgramsUniversity of Miami Miller School of MedicineMiamiUSA

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