Symptomatic carotid artery disease: current management recommendations.

Proper management of symptomatic carotid artery disease requires prompt diagnosis and therapy based on both the patient's symptoms and the nature of the carotid lesion. Duplex ultrasonography is the preferred diagnostic modality for evaluating symptomatic patients for the presence of a hemodynamically significant carotid lesion. Arteriography can confirm severe carotid stenosis or delineate a nonstenotic, ulcerated plaque before surgery. Antiplatelet and anticoagulant agents administered after transient ischemic attacks or completed stroke have shown questionable benefit in stroke reduction as an independent variable. Results of randomized clinical trials support the use of carotid endarterectomy for symptomatic patients with ipsilateral carotid stenosis greater than 70 percent. The operation should be performed for appropriate indications by surgeons whose perioperative morbidity and mortality rates meet established guidelines.