SAIMSARA Journal

Machine Generated Science • ISSN 3054-3991

Medication in Carotid Stenosis: Scoping Review with ☸️SAIMSARA.

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Vascular Health

Issue 1, Volume 1, 2026

Editorial note
• Last update: 2026-03-21 13:30:12
What is this paper about
This paper shows that in carotid stenosis, the real difference is not only who gets operated on, but who receives and continues the right medical therapy. It is worth reading because it identifies the medication strategies that most consistently align with better outcomes and exposes adherence as a major, underappreciated driver of prognosis.

DOI: 10.62487/saimsaraf51a30ef


Abstract: This paper aims to systematically review and synthesize the current evidence regarding the role and efficacy of different medication classes in the management of carotid stenosis, encompassing their impact on disease progression, procedural outcomes, neurological function, and overall patient survival. The review utilises 200 original studies with 1511101 total participants (topic deduplicated ΣN). Across the mapped evidence, medication use—particularly statins and antiplatelet therapy—emerged as a dominant signal associated with better clinical outcomes in carotid stenosis, including an HR of 0.61 for mortality with lipid-lowering medication in men after CEA and strong associations between statin/aspirin use and 5-year survival in asymptomatic CEA cohorts. The literature also consistently indicates that gaps in prescribing and, especially, nonadherence are clinically consequential, with discontinuation or nonadherence linked to recurrent ischemic events and worse long-term outcomes after revascularization. Beyond traditional agents, newer antiplatelet strategies (e.g., prasugrel, ticagrelor, Revacept) and selected metabolic/anti-inflammatory approaches show signals of feasibility or benefit in specific contexts, but remain comparatively immature and heterogeneous in endpoints and populations. Clinically, these findings support prioritizing durable implementation of optimal medical therapy—ensuring access, persistence, and peri-procedural appropriateness—alongside selective revascularization rather than viewing medication as a static background intervention. Future research should focus on adequately powered, context-specific comparative studies that standardize outcomes and rigorously measure adherence to determine which medication regimens (and durations) best balance ischemic protection, bleeding risk, restenosis prevention, and cognitive outcomes in defined carotid stenosis subgroups.
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Keywords: Carotid stenosis; Medical therapy; Antiplatelet agents; Statins; Antihypertensive drugs; Atherosclerosis; Stroke prevention; Cognitive function; Plaque stabilization; Pharmacological management

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