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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL2Fuc3dlcnMvNDYzMTQ3LTE1NTc5MS8yNTAwMDMyLW92ZXJ2aWV3\nDrugs & Diseases > Vascular Surgery > Atherosclerotic Disease of the Carotid Artery Q&A\nWhat is the role of pharmacologic therapy in the treatment of atherosclerotic disease of the carotid artery?\nAuthor: Jake F Hemingway, MD; Chief Editor: Vincent Lopez Rowe, MD more...\nAspirin (30-1350 mg/day) irreversibly acetylates the cyclooxygenase of platelets, thus inhibiting platelet synthesis of thromboxane A2. Prostacyclin production in the endothelium is reduced, but this effect is reversible and short-lived. A reduction in transient ischemic attacks (TIAs), stroke, and death in men was shown in the Canadian Cooperative Study Group. [15]\nStatins, which include atorvastatin, rosuvastatin, simvastatin, pravastatin, and lovastatin, are 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors that lower LDL cholesterol levels. Statin therapy, with a target low-density lipoprotein (LDL) level below 100 mg/dL, is recommended for all patients with extracranial carotid atherosclerotic disease. A lower target LDL level, 70mg/dL, is recommended in high-risk patients. [16]\nTiclopidine (250 mg q12hr) is a thienopyridine that irreversibly alters the platelet membrane and inhibits platelet aggregation. It is approximately 10% more effective than aspirin. Toxicity includes neutropenia and diarrhea. Clopidogrel (75 mg/day) is similar to ticlopidine; the risk of neutropenia is low.\nWarfarin (titrated international normalized ratio [INR] 2-3) use in patients with noncardiac emboli is controversial.\nAntiplatelet therapy (cilostazol) may reduce the progression of carotid artery stenosis after stent implantation. [17]\nNorth American Symptomatic Carotid Endarterectomy Trial Collaborators., Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991 Aug 15. 325 (7):445-53. [Medline].\nStroke facts. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/stroke/facts.htm. September 6, 2017; Accessed: February 21, 2019.\nYoung B, Moore WS, Robertson JT, Toole JF, Ernst CB, Cohen SN, et al. An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. ACAS Investigators. Asymptomatic Carotid Atherosclerosis Study. Stroke. 1996 Dec. 27 (12):2216-24. [Medline].\nMas JL, Trinquart L, Leys D, Albucher JF, Rousseau H, Viguier A, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol. 2008 Oct. 7 (10):885-92. [Medline].\nWiesmann M, Schöpf V, Jansen O, Brückmann H. Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis: meta-analysis of randomized trial data. Eur Radiol. 2008 Dec. 18 (12):2956-66. [Medline].\nMeier P, Knapp G, Tamhane U, Chaturvedi S, Gurm HS. Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials. BMJ. 2010 Feb 12. 340:c467. [Medline]. [Full Text].\nGurm HS, Yadav JS, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008 Apr 10. 358 (15):1572-9. [Medline]. [Full Text].\nIlluminati G, Ricco JB, Caliò F, Pacilè MA, Miraldi F, Frati G, et al. Short-term results of a randomized trial examining timing of carotid endarterectomy in patients with severe asymptomatic unilateral carotid stenosis undergoing coronary artery bypass grafting. J Vasc Surg. 2011 Oct. 54 (4):993-9; discussion 998-9. [Medline].\nBrown K, Itum DS, Preiss J, Duwayri Y, Veeraswamy RK, Salam A, et al. Carotid artery stenting has increased risk of external carotid artery occlusion compared with carotid endarterectomy. J Vasc Surg. 2015 Jan. 61 (1):119-24. [Medline].\nBrott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010 Jul 1. 363 (1):11-23. [Medline]. [Full Text].\nHill MD, Brooks W, Mackey A, Clark WM, Meschia JF, Morrish WF, et al. Stroke after carotid stenting and endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). Circulation. 2012 Dec 18. 126 (25):3054-61. [Medline].\nHye RJ, Mackey A, Hill MD, Voeks JH, Cohen DJ, Wang K, et al. Incidence, outcomes, and effect on quality of life of cranial nerve injury in the Carotid Revascularization Endarterectomy versus Stenting Trial. J Vasc Surg. 2015 May. 61 (5):1208-14. [Medline].\nBrott TG, Calvet D, Howard G, Gregson J, Algra A, Becquemin JP, et al. Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: a preplanned pooled analysis of individual patient data. Lancet Neurol. 2019 Feb 6. [Medline].\nvan Engelen A, Wannarong T, Parraga G, Niessen WJ, Fenster A, Spence JD, et al. Three-dimensional carotid ultrasound plaque texture predicts vascular events. Stroke. 2014 Sep. 45 (9):2695-701. [Medline].\nCanadian Cooperative Study Group. A randomized trial of aspirin and sulfinpyrazone in threatened stroke. N Engl J Med. 1978 Jul 13. 299 (2):53-9. [Medline].\n[Guideline] Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK, et al. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011 Sep. 54 (3):e1-31. [Medline].\nKato T, Sakai H, Takagi T, Nishimura Y. Cilostazol prevents progression of asymptomatic carotid artery stenosis in patients with contralateral carotid artery stenting. AJNR Am J Neuroradiol. 2012 Aug. 33 (7):1262-6. [Medline].\nOrrapin S, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev. 2017 Jun 7. 6:CD001081. [Medline].\nHalliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004 May 8. 363 (9420):1491-502. [Medline].\nNational coverage determination (NCD) for percutaneous transluminal angioplasty (PTA) (20.7). Centers for Medicare and Medicaid Services. Available at https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?ncdid=201. March 11, 2013; Accessed: February 21, 2019.\nMoore WS, Popma JJ, Roubin GS, Voeks JH, Cutlip DE, Jones M, et al. Carotid angiographic characteristics in the CREST trial were major contributors to periprocedural stroke and death differences between carotid artery stenting and carotid endarterectomy. J Vasc Surg. 2016 Apr. 63 (4):851-858.e1. [Medline].\nLal BK, Beach KW, Roubin GS, Lutsep HL, Moore WS, Malas MB, et al. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012 Sep. 11 (9):755-63. [Medline].\nArteriogram of aortic arch and its branches.\nArteriogram of carotid stenosis.\nAtherosclerotic plaque removed at time of carotid endarterectomy (areas of ulceration with thrombus and intraplaque hemorrhage are present).\nCarotid artery exposed prior to carotid endarterectomy (coil present in internal carotid artery).\nCarotid artery following endarterectomy and prior to closure (tapered endpoint and smooth appearance of lumen).\nCarotid artery following Dacron patch angioplasty.\nSelective left carotid angiogram.\nOblique view of left carotid artery demonstrating lesion within internal carotid artery.\nPlacement of stent into internal carotid artery. Note filter wire in upper photos (dots at top of internal carotid artery).\nAngioplasty after stent placement; again, note filter wire protecting distal carotid artery.\nCompletion arteriogram displaying improvement in diameter of internal carotid artery.\nNormal carotid arteries on color flow duplex ultrasonography.\nColor flow duplex ultrasonogram reveals 80-99% left carotid stenosis and normal right carotid.\nCarotid plaque.\nJake F Hemingway, MD Resident Physician in Integrated Vascular Surgery, Department of Surgery, University of Washington School of Medicine\nJake F Hemingway, MD is a member of the following medical societies: Society for Vascular Surgery\nNiten Singh, MD, FACS Associate Professor of Surgery, University of Washington School of Medicine; Director of Vascular Limb Preservation, Vascular Surgery Clinic at Harborview\nNiten Singh, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Society for Vascular Surgery\nVincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California\nVincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society\nApril L Rodriguez, MD, MS Senior Resident, Integrated Vascular Surgery Residency, Department of Surgery, University of Washington School of Medicine\nApril L Rodriguez, MD, MS is a member of the following medical societies: American College of Surgeons, Society for Clinical Vascular Surgery, Vascular and Endovascular Surgery Society\nDavid L Gillespie, MD, FACS, RVT, DMCC, COL, MC USA Chief and Program Director, Vascular Surgery Service, Walter Reed Army Medical Center; Professor of Surgery, Uniformed Services University of the Health Sciences; Vascular Surgery Consultant, Office of the US Army Surgeon General\nDavid L Gillespie, MD, FACS, RVT, DMCC, COL, MC is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Venous Forum, Eastern Vascular Society, Society for Vascular Surgery, and Southern Association for Vascular Surgery\nJames M Goff, MD Assistant Chief, Department of Surgery, Walter Reed Army Medical Center; Assistant Professor, F Department of Surgery, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences\nJames M Goff, MD is a member of the following medical societies: American College of Surgeons\nSean D O'Donnell, MD Director, Department of Surgery, Section of Vascular and Endovascular Surgery, Washington Hospital Center\nSean D O'Donnell, MD is a member of the following medical societies: American College of Surgeons and Association of Military Surgeons of the US"