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Secondary stroke prevention — ABIM Board MCQ

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HardNeurologySecondary stroke preventionABIM Board

A 66-year-old woman had a nondisabling ischemic stroke caused by symptomatic 80% left internal-carotid stenosis. She is medically stable, has reasonable operative risk and anatomy suitable for open surgery. Which additional secondary-prevention intervention is indicated?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Arrange timely carotid endarterectomy with intensive medical therapy

The best answer is “Arrange timely carotid endarterectomy with intensive medical therapy”. Severe symptomatic ipsilateral carotid stenosis after a nondisabling stroke benefits from timely revascularization in an appropriate surgical candidate, and carotid endarterectomy is the standard choice with suitable anatomy and operative risk. Stenting is selected according to anatomy and comorbidity rather than automatically. Intensive lipid, blood-pressure and antiplatelet management continues but does not negate the procedural indication.

Reference: 2021 AHA/ASA Secondary Stroke Prevention Guideline: https://www.ahajournals.org/doi/epdf/10.1161/STR.0000000000000375