<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:An 81-year-old woman presents to her physician complaining of occasional right-sided weakness in her arm and leg. She reports 3 such episodes over the last 6 months, each lasting only 1 hour and not significantly affecting her daily functioning. The patient denies numbness and tingling, pain, weakness in her left side, and changes in her speech. She has a past medical history of hypertension and coronary artery disease with stable angina, and her medications include 81 mg aspirin, 20 mg lisinopril, 5 mg amlodipine, and 20 mg atorvastatin daily. The patient reports a 40-pack-year smoking history and occasional alcohol intake. At this visit, her temperature is 98.5F 36.9C, blood pressure is 14287 mmHg, pulse is 70min, and respirations are 14min. She has a grade II systolic ejection murmur best heard at the right upper sternal border, and there is a carotid bruit on the left side. Her lungs are clear. Neurologic exam reveals intact cranial nerve function, 1 deep tendon reflexes in bilateral patellae and biceps, as well as 55 strength and intact pinprick sensation in all extremities. Carotid ultrasound is performed and identifies 52 stenosis on the right side and 88 on the left. Which of the following is the best next step in management?? A: Repeat carotid ultrasound in 6 months, B: Increase atorvastatin to 80 mg daily, C: Perform carotid artery angioplasty with stenting CAS, D: Perform carotid endarterectomy on both sides, E: Perform carotid endarterectomy on left side only,  <response>: This is a clinical case scenario involving an 81-year-old woman with a history of hypertension, coronary artery disease, and intermittent right-sided weakness concerning for transient ischemic attacks TIAs. She underwent carotid ultrasound showing moderate stenosis on the right and severe stenosis on the left. The key findings are the intermittent neurological symptoms concerning for TIAs and the significant carotid artery stenosis, especially on the left. The goal is to determine the best management to prevent future strokes.Choice A is incorrect because repeat ultrasound in 6 months would not address the underlying stenosis. Choice B is incorrect because simply increasing the statin dose does not address the mechanical obstruction from carotid stenosis. Choice C, stenting both sides, is too aggressive given the moderate stenosis on the right. Choice D, endarterectomy on both sides, is also too aggressive given the moderate right stenosis. Choice E, endarterectomy on the left side only, is the best option. This will directly address the severe left carotid stenosis that is likely the source of her symptoms. Endarterectomy is preferred over stenting given her age. E: Perform carotid endarterectomy on left side only 