A 72-year-old man presents for an out patient follow up after
being discharged from the hospital two days ago. He was admitted for a
transient ischemic attack on the right side of his body which resolved
spontaneously. He was worked up and subsequently discharged. Review of
his in-patient investigations reveal a carotid doppler which revealed
100% stenosis of the left carotid artery and a 40% stenosis of the right
carotid artery. He smoked about 1 pack per day for past several
years. His past medical history includes chronic atrial fibrillation for
which he has been on Aspirin alone. During the last admission, he was
started on Coumadin as well. Today, his INR is therapeutic at 2.5 . His
fasting lipid profile shows a calculated LDL cholesterol of 60mg%. On
examination, there are no neurological deficits. His blood pressure is
110/70 mm Hg. In addition to recommending smoking cessation and
lifestyle changes along with continuation of coumadin, which of
the following is most appropriate at this time?
A) Carotid Endarterectomy of Right Carotid Artery
B) Carotid Stenting of left carotid artery
C) Carotid Endarterectomy of Left Carotid Artery
D) Carotid Magnetic Resonance Angiography
E) No other intervention indicated
A) Carotid Endarterectomy of Right Carotid Artery
B) Carotid Stenting of left carotid artery
C) Carotid Endarterectomy of Left Carotid Artery
D) Carotid Magnetic Resonance Angiography
E) No other intervention indicated
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