Optimal Medical Therapy During Carotid Endarterectomy: A Personal View

Abstract

An important component in managing patients undergoing carotid endarterectomy (CEA) is ensuring that each receives appropriate peri-operative ‘best medical therapy’ as well as the assurance of a safely performed procedure. What exactly constitutes optimal medical therapy will, of course, vary both within and across health systems and has never been standardised. Accordingly, the suggestions made in this review reflect the author’s personal practice and are based upon a review of the currently available evidence. The principal themes are choice of antiplatelet therapy, statin therapy, blood pressure control, choice of intra-operative heparin, the use of targeted (selective) Dextran 40 therapy post-operatively and guidelines for managing post-operative hypertension.

Key Words:

• Carotid endarterectomy
• antiplatelet drugs
• Dextran 40
• stroke
• statins.

Additional information

Notes on contributors

A.R. Naylor

Prof. A. R. Naylor, M.D., F.R.C.S. Professor of Vascular Surgery Department of Vascular Surgery Clinical Sciences Building Leicester Royal Infirmary Leicester UK Tel.: [phone] Fax: [phone] E-mail: [email protected]