Antithrombotic Therapy in Carotid Artery Stenosis: An Update

Carotid stenosis is generally associated with high risks of stroke and vascular events. In asymptomatic and symptomatic patients, with or without revascularization, optimal managements of carotid artery stenosis require the use of medications or lifestyle modifications (stopping smoking and monitoring hypertension, hyperlipidemia, and diabetes) to control the processes associated with atheroma to reduce the risk of embolic events. Moreover, antiplatelet therapy should be considered. There is little evidence that antiplatelet therapy is beneficial in preventing stroke or the progression of stenosis in asymptomatic patients, whereas, evidence of a benefit from antiplatelet therapy for secondary prevention of recurrent stroke in symptomatic patients with carotid atherosclerosis is more robust. Also, in patients undergoing carotid endarterectomy, perioperative antiReceived: April 25, 2014 Accepted: August 31, 2014 Published online: November 7, 2014 Maurizio Paciaroni Stroke Unit and Division of Internal and Cardiovascular Medicine Santa Maria della Misericordia Hospital, University of Perugia Via G. Dottori 1 , IT-06100 Perugia (Italy) E-Mail maurizio.paciaroni @ unipg.it © 2014 S. Karger AG, Basel 0014–3022/14/0732–0051$39.50/0