usmle123
Forum Senior
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A 67 year old male pt come for routine physical exam. He has no complains. physical exam reveals a bruit in his neck. duplex ultrasonography reveals a 70% irregular lesion at the right common carotid artery bifurcation. Left common carotid artery has 40% lesion. What's the best next step management?
A. left carotid surgery
b. right carotid surgery
c. long term ASA therapy
d. heparin
e. bilateral carotid surgery
The answer is right carotid surgery. Based on my understanding, there is no endarterectomy if pt has no symptom. This patient has no syptom , why the answer is surgery?
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| AAzad
Forum Guru
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usmle123
Hi . I like your question it is a chalenge
Cea is not a difficult surgery in this age, and also it is not true that you do not perform CAE if it is asymptomatic 50-55 you do not perform surgery ,but 70 in age 67 is good candidate, heparin is not good choice , but Clopidogrel 75mg/day( it is better than ASA)
left carotid with 40% of occlusion is not indication for CEA,but 40% is remaining , you watch it(not agood idea to perform both side same time.
It is my idea of carotid endarterectomy, What do you think?
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AAzad
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| AAAAA
Forum Fanatic
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agree
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| usmle123
Forum Senior
Topics: 20
Posts: 43
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Hi, AAzad, great explanation and i agree with your idea.
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