Pharmacotherapy for patients undergoing carotid stenting

Stroke is the second most common cause of death worldwide [Murray CJ, Lopez AD. Mortality by cause for eight regions of the World: Global Burden of Disease Study, Lancet 1997;349:1269-76. [1]] and remains one of the most common and disabling neurological disorders, particularly in the elderly. Survivors of stroke remain at high risk for developing further vascular events including recurrent strokes, myocardial infarction and vascular deaths. Treatment modalities for such patients include life style modifications, drug therapy and where applicable, surgical or endovascular intervention. Carotid artery disease is implicated in 20-30% of the population as the aetiology for stroke [De Bakey ME. Carotid endarterectomy revisited, J Endovasc Surg 1996;3:4. [2]]. This article examines the pharmacotherapy for patients undergoing carotid stenting. This will be divided into best medical therapy for these patients, and is the same as that that should be given to all patients following transient ischaemic attack (TIA) or stroke. It will provide a concise description of the safety profile, dosage, indications and contraindications of the various drugs that are currently available to reduce the risk of further TIA or stroke. Then the specific drugs used in the peri-procedural period during carotid stenting will be described, along with the evidence supporting their use.