ABSTRACT

All patients with symptomatic ICA occlusion should be treated with an antiplatelet agent, aspirin in most patients, with rigorous control of vascular risk factors such as hyperlipidemia, diabetes mellitus, smoking, and obesity. It should be noted that this recommendation is based on extrapolation of the results of studies on secondary prevention of stroke in general. If patients have ongoing transient ischemic attacks despite aspirin, oral anticoagulation may be prescribed instead (1) but again evidence from randomized controlled trials is not available. Furthermore, in our experience, the change from aspirin to oral anticoagulants rarely results in cessation of symptoms, especially in patients with clinical features suggesting a hemodynamic cause. The treatment of hypertension should be performed prudently because aggressive treatment may actually induce cerebral ischemic symptoms in patients with symptomatic carotid artery occlusion (52).