MedBulletin May 2022

The image shows a left internal carotid artery plaque in a 68 year old male with a history of 3 Transient ischemic attacks in 2 months. The plaque shows Type 2 (predominantly echolucent) morphology, with a Type 2 (irregular) surface, and is causing 80% stenosis in the artery. He has no other major cardiovascular co-morbidities. Recommended treatment options for this patient would be (you may choose more than one option)

1. Aggressive lipid control with statins or evolocumab
2. Aspirin with low dose Rivaroxaban
3. Anti-coagulation with a direct oral anti-coagulant
4. Dual anti-platelet therapy with Aspirin and Clopidogrel
5. Left carotid endarterectomy
6. Left carotid artery stenting

Answer – a, d, e