These observations need confirmation in larger

patients cohorts, with special focus on the optimal threshold of post-operative CHS prediction. In our study, only 5 of all patients developed CHS. The low incidence of CHS hampers the interpretation of our results. However, the incidence in our group of patients (7%) is relatively high compared to other series. This might be explained by the fact that in our referral hospital a selected group of patients with relatively severe hemodynamic compromise are treated, which is also reflected in the relatively high number of patients in whom a shunt was used (31%). In addition, Natural Product Library clinical trial data were collected retrospectively, and were more likely to be complete (i.e., including post-operative measurements) in patients with an intra-operative Vmean increase of >100%, or in patients who developed post-operative TGF-beta inhibitor hypertension. However, prospectively collected data in another large vascular training hospital show similar results and thus confirm our findings [12]. A multicenter prospective study to optimize the post-operative TCD-measurements will start in 2012. Besides the commonly used intra-operative TCD monitoring, additional TCD measurement in the early post-operative phase

is useful to predict CHS in patients that underwent CEA under general anesthesia. By measuring Vmean in the post-operative instead of only in the intra-operative Morin Hydrate phase, both the positive and negative predictive value of TCD for development of CHS after CEA can be improved. Therefore, we recommend a baseline measurement before the administration of anesthetics and a post-operative measurement within two hours after surgery. “
“Atherosclerotic stenosis of the internal carotid artery is known as a major risk factor for disabling stroke or death leading to enormous socioeconomic problems. The standard

therapy for a symptomatic stenosis of the internal carotid artery has been a carotid endarterectomy (CEA) in combination with best medical treatment of concomitant cerebrovascular risk factors. In recent years, carotid angioplasty and stenting (CAS) has widely been used as a treatment of first choice in many patients, despite the fact that the randomized controlled trials and subsequent meta-analyses could not prove a general superiority of CAS over CEA [1], [2], [3], [4], [5] and [6]. However, the results of the aforementioned trials have been interpreted very controversely resulting in conflicting recommendations in various current guidelines. In the American guidelines, for instance, the authors concluded that CAS could be used as an equivalent treatment modality to CEA in medium risk patients with a symptomatic carotid stenosis [7], whereas elsewhere, CEA still is advocated as the first treatment of choice [8].