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Practice Current: How do you manage patients with a "hot carotid"?

While recognizing each case is different, please choose the answer that best reflects your common practice and limit free text to strategies that are not included.

Estimated Time: 2 Minutes

CASE
A 65-year-old patient presents with acute-onset of right-sided weakness lasting several hours and is found to have 80% left-sided extracranial internal carotid artery stenosis. After appropriate hyper-acute management, a plan is made for revascularization (endarterectomy or stenting) within the next week. A statin is started.
1. What diagnostic imaging modality or modalities do you prefer for evaluating the presence and extent of carotid stenosis? Please select the option you use most often, but if you routinely use two or more imaging modalities for each patient, then please select all the options you use. *This question is required.
  • * This question is required.
2. What is your preferred procedure for revascularization for patients with significant and symptomatic carotid stenosis? *This question is required.
3. How long after their symptomatic event do patients typically wait for carotid revascularization? *This question is required.
The questions that follow are about the short-term anti-thrombotic program that you will consider in this case.

CASE
A 65-year-old patient presents with acute-onset of right-sided weakness lasting several hours and is found to have 80% left-sided extracranial internal carotid artery stenosis. After appropriate hyper-acute management, a plan is made for revascularization (endarterectomy or stenting) within the next week. A statin is started.
4. Based on just this information, what anti-thrombotic agents will you typically favor in this patient while awaiting carotid revascularization (endarterectomy/stenting)? Please select all options you would order as part of this patient’s anti-thrombotic regimen.
  *This question is required.
  • * This question is required.
5. If this patient was already on low-dose ASA (75 to 81mg daily), what anti-thrombotic agents will you typically favor in this patient while awaiting CEA/CAS? Please select all options you would order as part of this patient’s anti-thrombotic regimen. *This question is required.
6. If there is evidence of an intravascular thrombus at the area of carotid stenosis in this patient, what anti-thrombotic agents will you typically favor in this patient while awaiting CEA/CAS? Please select all options you would order as part of this patient’s anti-thrombotic regimen. *This question is required.
7. What clinical features would INCREASE your enthusiasm for additional agents beyond a single anti-platelet and statin therapy? Please select all that apply. *This question is required.
8. What imaging features would INCREASE your enthusiasm for additional agents beyond a single anti-platelet and statin therapy? Please select all that apply. *This question is required.
9. What clinical features would LOWER your enthusiasm for additional agents beyond single antiplatelet and statin therapy (assuming there is no other bleeding diathesis)? Please select all that apply. *This question is required.
10. What imaging features would LOWER your enthusiasm for agents beyond single antiplatelet and statin therapy (assuming there is no other bleeding diathesis)? Please select all that apply. *This question is required.