1. In patients with carotid artery stenosis, regardless of whether or not intervention is planned, treatment of hypertension, hypercholesterolemia, a nd efforts at smoking cessation are recommended to reduce overall cardiovascular risk and risk of stroke. Targets are those defined by the National Cholesterol Education Program guidelines (Grade 1, Level A).
2. Aggressive treatment of hypertension in the setting of acute stroke is not recommended, however, treatment of hypertension after this period has passed is associated with reduced risk of subsequent stroke. The target parameters are not well defined (Grade 1, Level C).
3. Treatment of diabetes with the goal of tight glucose control has not been shown to reduce stroke risk, or decrease complication rates after CEA, and is not recommended for these purposes (Grade 2, Level A).
4. Anticoagulation is not recommended for the treatment of transient ischemic attack (TIA) or acute stroke unless there is evidence of a cardioembolic source (Grade 1, Level B).
5. Antiplatelet therapy in asymptomatic patients with carotid atherosclerosis is recommended to reduce overall cardiovascular morbidity although it has not been shown to be effective in the primary prevention of stroke (Grade 1, Level A).
6. Antiplatelet therapy is recommended for secondary stroke prevention: aspirin, aspirin combined with dipyridamole and clopidogrel are all effective. Clopidogrel combined with aspirin is not more effective than either drug alone (Grade 1, Level B).
7. Perioperative medical management of patients undergoing carotid revascularization should include blood pressure control (<140/80 mmHg), beta blockade (HR 60-80 bpm), and statin therapy (LDL 100 mg/dL) (Grade 1, Level B).
8. Perioperative antithrombotic therapy for CEA should include aspirin, (81-325 mg) (Grade 1, Level A). The use of clopidogrel in the perioperative period should be decided on a case by case basis (Grade 2, Level B).
9. Perioperative antithrombotic management of CAS patients should include dual antiplatelet therapy with aspirin and either ticlopidine or clopidogrel. Dual antiplatelet therapy should be initiated at least 3 days prior to CAS and continued for 1 month and aspirin therapy should be continued indefinitely (Grade 1, Level C).