Carotid Artery Disease — Stenosis and Management

A 55-year-old man with hypertension and hyperlipidemia undergoes duplex ultrasound for carotid stenosis screening. The right internal carotid artery shows a peak systolic velocity of 280 cm/s and an end-diastolic velocity of 85 cm/s. What is the approximate degree of stenosis, and what is the recommended management?

A 72-year-old woman from Mumbai is found to have a 85% asymptomatic left carotid artery stenosis on screening duplex ultrasound performed for hypertension evaluation. She has no history of stroke, TIA, or amaurosis fugax. Her comorbidities include well-controlled type 2 diabetes, hypertension on three agents, and mild COPD. Coronary angiography 6 months ago showed no significant coronary artery disease. What is the most appropriate management?

A 68-year-old man with hypertension and type 2 diabetes presents to the outpatient clinic with a 2-month history of transient visual loss in the left eye lasting 2–3 minutes, which resolved completely. On examination, a left carotid bruit is audible. Duplex ultrasound reveals 70% stenosis of the left internal carotid artery (ICA). CT angiography shows no acute stroke. What is the most appropriate next step in management?

A 68-year-old man from Delhi presents with a 3-month history of transient monocular vision loss (amaurosis fugax) lasting 2–3 minutes, which resolved completely. Neurological examination is normal. Carotid duplex ultrasound shows a 70% stenosis of the left internal carotid artery with an irregular plaque. CT brain is normal. What is the most appropriate next step in management?

A 72-year-old woman with a history of hypertension and atrial fibrillation is found to have asymptomatic left carotid artery stenosis of 85% on screening duplex ultrasound performed during evaluation for a cardiac murmur. She is on warfarin for stroke prevention. Carotid angiography confirms the stenosis with no evidence of ulceration. She has no history of stroke or TIA. What is the most appropriate management strategy?