Abstract
Medical treatment is indicated for all patients with symptomatic or high‐risk asymptomatic extracranial vascular disease, whether or not a vascular intervention is planned or has been performed. Recent evidence mandates an aggressive approach to management of traditional vascular risk factors, frequently involving use of several medications concurrently such as angiotensin converting enzyme inhibitors, diuretics and statins. These treatments should be considered for all patients, including those with blood‐pressure and/or cholesterol measurements within what might be considered the “normal” range. However, treatment decisions should be tailored to individual patient circumstances. Vascular anatomical considerations must be taken into account, particularly the presence of severe bilateral internal carotid artery stenoses or occlusion. Combination antiplatelet therapy with aspirin plus dipyridamole is generally indicated for secondary prevention of cerebrovascular disease, whilst clopidogrel is used following stent placement. Advances in medical management of extracranial vascular disease which reduce the overall risk of cerebrovascular events have been introduced subsequent to some of the pivotal carotid surgery trials. Possible implications for surgical treatment decision‐making will be addressed.
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