A 67-year-old man is evaluated for a carotid bruit detected on routine medical examination. He reports no history of previous focal neurologic symptoms or visual loss. He has type 2 diabetes mellitus and hyperlipidemia treated with metformin, moderate-intensity pravastatin, and aspirin. On physical examination, blood pressure is 128/64 mm Hg, pulse rate is 78/min and regular, and respiration rate is 16/min. A left carotid bruit is heard on cardiac examination. All other physical examination findings, including those from a neurologic examination, are unremarkable. Results of laboratory studies show an LDL cholesterol level of 82 mg/dL (2.12 mmol/L). The carotid ultrasound report describes a mixed-density plaque at the origin of the left internal carotid artery with stenosis estimated to be 60% to 80%.
Which of the following is the most appropriate next step in management?
A Carotid endarterectomy
B Carotid stenting
C Magnetic resonance angiography of the neck
D Replacement of aspirin with clopidogrel
E No further treatment or intervention
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