North American surgeons are more likely to intervene in asymptomatic carotid artery disease. If a transient ischemic attack or stroke occurs, either should be investigated and managed in a specialist center offering organized stroke care. There is increasing evidence that early intervention, the time window being as little as three hours, may reduce long-term disability and death. Very few places are at present able to meet this time frame. Patients need immediate access to appropriate investigations, including computed tomography or magnetic resonance imaging, and access to specialists who understand the management of multiple risk factors and the likely outcome of intervention.
Anticoagulation is essential for patients with atrial fibrillation without contraindications.
There is now a clear place for cholesterol lowering and the use of statins in secondary prevention. Common sense suggests interventions that are effective in primary prevention, such as cessation of smoking and increased physical activity, remain important in secondary prevention but are unproven. About the Authors From the Academic Department of Geriatric Medicine and Gerontology, University of Birmingham, United Kingdom. Warlow CP, et al. A Practical Guide to Management .