Early carotid intervention such as carotid endarterectomy or CAS after a neurologic event carries a higher risk of perioperative complications, but this strategy can prevent more subsequent ischemic events than delayed intervention. Statins are known to stabilize vulnerable carotid plaque by improving endothelial function, decreasing platelet thrombus formation, and reducing inflammation at the lesion site. Low levels of omega-3 fatty acid ethyl esters eicosapentaenoic acid and docosahexaenoic acid have been associated with unstable carotid plaque and CAS-related thromboembolic complications, suggesting that supplementation might result in reducing recurrent stroke.1 Therefore, omega-3 fatty acid pretreatment may stabilize carotid plaque before CAS treatment. It would be wonderful if we could prescribe a medical “cocktail” after a neurologic event that would prevent recurrent stroke for a couple of weeks and thereby render urgent carotid endarterectomy or CAS safer. If this cocktail truly worked, there might not be a need for urgent or emergent carotid interventions. If the results documented a significant benefit of this cocktail in reducing recurrent strokes, I also wonder if the addition of an omega-3 fatty acid to aspirin, clopidogrel (Plavix), and a statin would render prophylactic carotid intervention obsolete.
Reference link- https://www.jvascsurg.org/article/S0741-5214(20)31347-1/fulltext