A 45-year-old man with a 20-year smoking history and uncontrolled hypertension (BP 168/98 mmHg, HR 92 bpm) presents with transient monocular vision loss lasting 15 minutes that completely resolved. Neurologic examination is intact with no focal deficits. Carotid ultrasound reveals 70% stenosis of the right internal carotid artery with irregular ulcerated plaque. LDL cholesterol is 156 mg/dL. Which of the following is the most appropriate management?
- A)Warfarin anticoagulation to prevent cardioembolic stroke
- B)Immediate thrombolytic therapy for acute stroke
- C)Carotid endarterectomy or endovascular stenting plus medical optimizationGABARITO
- D)Aspirin monotherapy with serial carotid ultrasound surveillance
- E)Conservative observation with blood pressure control alone
Explicação
Transient monocular vision loss (amaurosis fugax) indicates TIA from carotid stenosis. A 70% stenosis with symptomatic disease (prior TIA) is an indication for revascularization, either CEA or CAS, plus antiplatelet agents and risk factor modification to preve... Ver explicação completa e trilha adaptativa →