MRCP2-3526

MRCP2-3526

A 70-year-old man presents with sudden onset expressive dysphasia and right hemiparesis. He has a history of smoking 20 cigarettes per day and drinking ten units of alcohol per week. He is also hypertensive and takes 2.5 mg of bendroflumethiazide. On examination, he has expressive aphasia, right-sided homonymous hemianopia, and a right extensor plantar response. CT brain shows a left middle cerebral artery territory ischemic stroke. His ECG shows sinus rhythm, and Doppler of carotids shows 20-30% stenosis of the right internal carotid artery and 40% stenosis of the left internal carotid artery. He has been started on aspirin 300 mg per day and simvastatin 40 mg on the day of admission. All investigations have been completed by day three of his admission. What is the next most appropriate step in management?