An arteriogram of a 75-year-old man is shown below. He have an asymptomatic carotid bruit. The patient has mild hypertension and mild COPD. The current recommendation for this man would be

In a recent prospective, randomized, multicenter trial involving 1662 patients in a study known as the Asymptomatic Carotid Atherosclerosis Study, patients with asymptomatic carotid artery stenosis of 60% or greater reduction in diameter and whose general health made them good candidates for elective surgery were found to have a significant reduction in the 5-year risk for ipsilateral stroke with surgery compared with medically treated cohorts (5.1 vs. 11.0%). Medically treated patients were treated with aspirin on a daily basis. Warfarin has not been shown to be effective in the management of patients with carotid disease. Angioplasty of carotid stenoses is being performed in some institutions on a purely investigational basis and to date has not replaced surgery as the treatment for high-grade carotid stenoses.