A patient in the ER experiences sudden loss of consciousness and motor function with a diagnosis of TIA. What is the next step in management for the 92-95% carotid occlusion?

The correct management of a patient with a transient ischemic attack (TIA) and significant carotid occlusion primarily revolves around the risk of further cerebrovascular events. With 92-95% occlusion, the risk of a full-blown stroke is substantially high, necessitating immediate and aggressive intervention.

In this scenario, referring the patient for immediate carotid endarterectomy is crucial. This surgical procedure involves the removal of plaque buildup from the carotid arteries to restore normal blood flow and reduce the risk of future strokes. Given the severity of the carotid occlusion and the presence of neurological deficits, immediate intervention can prevent further ischemic events.

In contrast, initiating anticoagulation therapy might be beneficial in specific contexts, but it is not the immediate step warranted with such high-level occlusions. Similarly, while starting statin therapy is important for long-term cardiovascular health and can help manage cholesterol levels, it does not address the acute risk associated with such significant occlusion.

Exploring the left carotid first and delaying treatment for the right side would not be appropriate management for a patient experiencing acute symptoms from critical occlusion. Immediate action on the most severely affected area – which is typically the common carotid artery – is essential to safeguard the patient’s