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Carotid Artery Stenosis — SCE Neurology MCQ

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EasyCerebrovascular DiseaseCarotid Artery StenosisSCE Neurology

A 70-year-old man with a history of ischaemic stroke 3 months ago presents with recurrent TIAs despite being on clopidogrel 75 mg daily. His carotid Doppler shows a 80% stenosis of the symptomatic left internal carotid artery. What is the most appropriate management?

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Correct answer: C — Refer for carotid endarterectomy

Symptomatic carotid stenosis of 50–99% (NASCET criteria) should be referred for carotid endarterectomy, ideally within 2 weeks of the index event. The ECST and NASCET trials showed clear benefit for surgery in symptomatic stenosis >70%. A: Increasing clopidogrel dose has no evidence base. B: Long-term dual antiplatelet therapy increases bleeding risk without proven benefit for carotid stenosis. D: Dipyridamole monotherapy is less effective than clopidogrel. E: Anticoagulation is not indicated for extracranial carotid atherosclerosis.

Reference: NICE NG128 (2019); NASCET Trial (1991)