07-24-2011, 09:30 AM
A 64-year-old man is evaluated because he lost vision in the lower field of his right eye for about 10 minutes yesterday. He wants a referral to see an ophthalmologist. His medical history includes hypertension and he is a former smoker. His medications are aspirin and enalapril.
Blood pressure is 142/90 mm Hg. Physical examination is normal. Carotid ultrasonography reveals 70% to 80% stenosis of the right internal carotid artery and 80% to 90% stenosis of the left internal carotid artery. He has no known contraindications to carotid intervention.
Which of the following is the most appropriate next step in the management of this patient?
A Right carotid endarterectomy
B Left carotid endarterectomy
C Switch aspirin to warfarin
D Add clopidogrel to aspirin
E No change in therapy
Blood pressure is 142/90 mm Hg. Physical examination is normal. Carotid ultrasonography reveals 70% to 80% stenosis of the right internal carotid artery and 80% to 90% stenosis of the left internal carotid artery. He has no known contraindications to carotid intervention.
Which of the following is the most appropriate next step in the management of this patient?
A Right carotid endarterectomy
B Left carotid endarterectomy
C Switch aspirin to warfarin
D Add clopidogrel to aspirin
E No change in therapy