Patients with symptomatic tight carotid stenosis have an increased short-time risk of stroke and an increased long-term risk of ischaemic vascular events compared with the general population. The aim of this study is to assess the safety, efficacy, and limitations of urgent CEA or CAS, in patients with carotid stenosis greater than 70% and clinically characterized by recurrent TIA or brain damage following a stroke (<2.5？cm). This study involved 28 patients divided into two groups. Group A consisted of sixteen patients who had undergone CEA, and group B consisted of twelve patients who had undergone CAS. Primary endpoints were mortality, neurological morbidity (by NIHSS) and postoperative hemorrhagic cerebral conversion, at 30 days. Ten patients (62.5%) of group A experienced an improvement in their initial neurological deficit while in 4 cases (26%) the deficit remained stable. Two cases of neurologic mortality are presented. At 1 month, 9 patients (75%) of group B experienced an improvement in their initial neurological deficit while 3 patients (25%) had a neurological impairment. Urgent or deferred surgical or endovascular treatment have a satisfactory outcome considering the profile in very high-risk patient population. Otherwise in selected patients CEA seems to be preferred to CAS. 1. Introduction Ipsilateral >50% carotid stenosis is found in about 10% of carotid territory ischaemic strokes and in about 15% of TIAs (transitory ischemic attack), and is associated with a particularly high risk of recurrent stroke [1–3], both in the acute phase and long term [4]. Recent studies showed that 4？20% of TIA patients will have a stroke within 90 days after a TIA, half within the first 2 days [5, 6]. Reanalysis of controlled trials of CEA (carotid endarterectomy) indicated that surgery conferred the greatest benefit when performed in the first 2 weeks following the index symptoms, perhaps as early as 48？h after the index event [7, 8]. Delaying intervention quite probably means that patients are better selected and this could guarantee better early outcomes, but this delay can also result in an interval stroke rate of 9–15% [9]. In the past few years CAS (carotid artery stenting) has emerged as a treatment alternative to CEA. A recent study found that early CAS might be associated with an increased risk for stroke and death [10]. In fact CAS, in the acute stage, remains challenging because of the limited therapeutic window and risk of hyperperfusion syndrome or cerebral hemorrhagic infarction after revascularization [11]. The real goal of early treatment is
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