patient with symptomatic Carotid artery stenosis - rahal

[ArchivalUser]

the patient is 65y/o and the stenosis is of 40%...developed TIA event...how do u traet?
1-aspirin
2-clopidogrel
3-endarterectomy.

it is clear that surgery is not indicated in less than 70% stenosis...what do u think about the other two choices?

[ArchivalUser]

ASA, asa is cheap and good as well clopidogrel, if you ask what is the best magament I will choose ASA, if allergic is presented clopidogrel.

[ArchivalUser]

ASA is the first choice in case the patient is asymptomatic...is it the same here?

[ArchivalUser]

Hi,
i think whatever be the percentage of stenosis, if he develops a sysmtpoms we should treat it,....there is a catch opint in that...u should which side did he develop the stenosis.

no symptoms but stenosis is present then ASA....on ASA if he develops a symptoms then its asprin resistance then we should give Cloprigel

more than 70 percentage....surgery...correct me if i am wrong

[ArchivalUser]

thanks usmle63 , I agree with u, but what about symptoms with less than 70%...u didn't explain it ?
after looking at it from many sources..i think it is aspirin what should be given.
thank you anyway.

[ArchivalUser]

great usmle63

[ArchivalUser]

Hi,
yes i agree...sorry i forgot to type that...
when are u giving ur step 3

[ArchivalUser]

i took my step3. waiting for score, and preparing again for it...just in caes...
GL

[ArchivalUser]

criteria are of endartrectomy:

1: 70 % stenosis symptomatic
2: 90% stenosis with asymptomatic.
3: 70% stenosis with asymptomatic with ulcerated plaque.
4 50-60% symptomatic could be benificial but not recomended.
<50% absolutely medical treatment and like aspirin and simvastatin.
please see

http://www.emedicine.com/radio/topic133.htm
http://www.aafp.org/afp/20000115/400.html