Contemporary Medical Management of Carotid Artery Stenosis.

The prevalence of carotid artery stenosis is expected to increase as the population ages. Patients with carotid disease face an elevated risk of cerebrovascular and cardiovascular (CV) complications, including stroke, transient ischemic attack, myocardial infarction, and CV death. Recommended lifestyle modifications emphasize adherence to a Mediterranean-style diet, regular physical activity, and smoking cessation, with pharmacologic support such as varenicline or combination nicotine replacement therapy as appropriate. Core medical therapies include low-dose aspirin monotherapy (or a P2Y12 receptor antagonist in cases of aspirin allergy or intolerance), high-intensity statin therapy, and blood pressure control. Patients with diabetes should be managed per current guidelines, with preference for SGLT2 inhibitors and GLP-1 receptor agonists due to their CV benefits.