A 64-year-old man with hyperlipidemia and hypertension taking lisinopril presents with recurrent episodes of monocular transient vision loss lasting 5-10 minutes. Vital signs: BP 148/92 mmHg, HR 78/min, RR 16/min, temp 37°C. Duplex ultrasound demonstrates 50% stenosis of the right internal carotid artery with heterogeneous plaque; LDL cholesterol 165 mg/dL. No acute stroke on brain MRI. Which intervention is most appropriate?
- A)Perform emergent carotid endarterectomy within 24 hours
- B)Initiate intravenous thrombolytic therapy
- C)Observe conservatively without intervention
- D)Initiate aspirin and schedule elective carotid endarterectomyGABARITO
- E)Start high-dose anticoagulation with warfarin immediately
Explicação
Symptomatic carotid stenosis 50-99% with amaurosis fugax (TIA equivalent) warrants antiplatelet therapy and elective carotid endarterectomy to reduce stroke risk by approximately 50%. Elective timing avoids perioperative complications. Ver explicação completa e trilha adaptativa →