What is the role of pharmacologic therapy in the treatment of atherosclerotic disease of the carotid artery?

Updated: Oct 04, 2018
  • Author: Jake F Hemingway, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Aspirin (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. [14]

Statins, 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. [15]

Ticlopidine (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.

Warfarin (titrated international normalized ratio [INR] 2-3) use in patients with noncardiac emboli is controversial.

Antiplatelet therapy (cilostazol) may reduce the progression of carotid artery stenosis after stent implantation. [16]


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