Secondary Prevention

Nonpharmacologic Therapy Carotid Endarterectomy

The benefit of carotid endarterectomy for prevention of recurrent stroke has been stud-

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ied previously in major trials. ' A recent meta-analysis has been completed that has combined these clinical trials to evaluate 6,092 patients.35 Carotid endarterectomy has been shown to be beneficial for preventing ipsilateral stroke in patients with symptomatic carotid artery stenosis of 70% or greater and is recommended in these patients. In patients with symptomatic stenosis of 50% to 69%, a moderate reduction in risk is seen in clinical trials. In those patients with stenosis of 50% to 69% and a recent stroke, carotid endarterectomy is appropriate. In other patients, surgical risk factors and surgeon skill should be considered prior to surgery. Carotid endarterectomy is not beneficial for symptomatic carotid stenosis less than 50% and should not be considered in these patients.

The Prevention and Treatment of Headaches

The Prevention and Treatment of Headaches

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