When a diagnosis has been determined and the assessment made, the physician must decide which therapy(ies) to prescribe for the patient.

A - Treatment of atherosclerosis risk factors

The atherosclerosis risk factors must always be treated (diabetes, hypercholesterolemia, etc.). The sole exception is hypertension in the event of hyper-narrow carotid stenosis. In effect, a sudden lowering of arterial pressure could reduce the blood flow downstream of the stenosis and cause a cerebral infarction.

B - Treatment of atheromatous plaque

As regards treatment of atheromatous plaque by a fluidizing therapy (platelet inhibiting therapy or anticoagulant therapy) or surgical treatment, the physician has three possible alternatives:

1) Prescribe neither anticoagulant nor any surgical procedure if the atheromatous plaque carries only a low risk of causing a neurological incident.

2)Prescribe a fluidizing therapy without surgery if the atheromatous plaque is not sufficiently altered to require an ablation.

3)Refer the patient to a surgeon if he believes that the atheromatous plaque is threatening.

VERY IMPORTANT :

A surgical procedure on the carotid artery is not an insignificant procedure and must be performed only to remove atheromatous plaque carrying a high risk of neurological incident.