For a patient with multiple episodes of amaurosis fugax, what is the most likely next step in management?

In cases of amaurosis fugax, which presents as brief episodes of vision loss due to transient ischemia, the underlying cause often involves significant carotid artery disease. The primary concern is to determine the presence and extent of any vascular issues that could lead to a more permanent loss of vision or a cerebrovascular event.

The most appropriate next step in managing a patient experiencing multiple episodes of amaurosis fugax is immediate angiography. This diagnostic procedure is critical as it allows healthcare providers to visualize the carotid arteries directly, assess for stenosis or occlusion, and quantify the severity of vascular compromise. Identifying these conditions is vital for determining the correct intervention, which may include surgical options such as carotid endarterectomy or stenting to prevent more serious complications.

Observation does not provide any active intervention or risk assessment for the underlying causes like carotid artery stenosis, making it less suitable for a patient with recurrent symptoms. Medications might play a role later in the management plan but are not the primary next step in this acute setting. Physical therapy is irrelevant, as it does not address the vascular complaints associated with amaurosis fugax. Thus, immediate angiography is the best option for appropriate and timely management.