If a patient is symptomatic from carotid disease and has 60% carotid occlusion, which management is most appropriate?

• A. Carotid endarterectomy
• B. Medical management with statin and antiplatelet therapy
• C. Carotid artery stenting
• D. Observation only

Answer: (B)

In symptomatic carotid disease, how much the artery is narrowed guides whether surgery adds meaningful benefit. With moderate stenosis around 60%, the potential stroke risk reduction from carotid endarterectomy or stenting is limited, and the perioperative risks may outweigh the benefit. Therefore the best approach is aggressive medical therapy to prevent further events. This includes antiplatelet treatment to reduce thromboembolism, and a high-intensity statin to lower LDL and stabilize the plaque, along with rigorous control of blood pressure, diabetes, and lifestyle factors.

Surgical options like endarterectomy or carotid stenting are typically reserved for higher-grade stenosis (generally greater than about 70% with symptoms) or for selected patients based on overall surgical risk and anatomy. Observation alone isn’t appropriate in a symptomatic patient because the risk of recurrent stroke remains elevated without treatment.