SYMPTOMATIC CAROTID-ARTERY DISEASE - CURRENT MANAGEMENT RECOMMENDATIONS

Proper management of symptomatic carotid artery disease requires promp t diagnosis and therapy based on both the patient's symptoms and the n ature of the carotid lesion. Duplex ultrasonography is the preferred d iagnostic modality for evaluating symptomatic patients for the presenc e of a hemodynamically significant carotid lesion. Arteriography can c onfirm severe carotid stenosis or delineate a nonstenotic, ulcerated p laque before surgery. Antiplatelet and anticoagulant agents administer ed after transient ischemic attacks or completed stroke have shown que stionable benefit in stroke reduction as an independent variable. Resu lts of randomized clinical trials support the use of carotid endartere ctomy for symptomatic patients with ipsilateral carotid stenosis great er than 70 percent. The operation should be performed for appropriate indications by surgeons whose perioperative morbidity and mortality ra tes meet established guidelines.