Medical treatment in carotid artery disease. Review

Stroke is an enormous public health problem in the western world and the third most common cause of death in the United States. Carotid artery disease is an important cause of stroke and its cause is most often atherosclerosis. There are two main strategies for the treatment of carotid stenosis. The first is to stabilize the progression of the carotid plaque through lifestyle changes, risk factor modification and drugs administration, and the second one, is to eliminate the carotid plaque by angioplasty. Major trials have established carotid endarterectomy as the "gold standard" treatment option in patients with severe (>70%) carotid stenosis. More recently, carotid artery stenting has been proposed as an alternative to carotid endarterectomy. The role of endovascular treatment in carotid disease will be established with the completion of ongoing large randomized trials. Surgical or endovascular angioplasty which is the mainstay of therapy of severe carotid stenosis, is beyond the scope of this review. Actually, the aim of this study is to review evidence for the very best medical treatment of patients with carotid artery disease.