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Accepted for endarterectomy, to stenting as well. The American Heart Association has set guidelines for the performance of surgery, according to which the treatment of severe extracranial carotid stenosis should only be performed if the cumulative perioperative stroke and death rate can be kept 6% in symptomatic and 3% in asymptomatic patients. 19, 20 In our study, the cumulative 30-day rate of stroke among patients was 2.36 %6 ; , and thus, fell near the figures on guidelines. In less selected groups of patients, less favorable results of endarterectomy have been reported. For instance, in the Veterans Affairs Cooperative Study, the rate in surgically treated asymptomatic patients was 4.7% .21, 22 Thus, the 30-day clinical outcomes observed in our registry appear similar to the best results obtained with carotid endarterectomy particularly if we consider that many patients in our study would have been ineligible for NASCET because of comorbid medical conditions. Roubin et al. observed a 7.3% cumulative 30-day stroke death rate, and Wholey et al reported a 5.9% rate without cerebral protection.1, 3 During unprotected stent implantation, the incidence of stroke and death was even higher in symptomatic patients 8.2% ; and in patients aged 80 years 16.0% ; .1 In our study, the incidence of stroke death was not significantly different for symptomatic and asymptomatic lesions, and also among patients aged 80 or 80 years, suggesting that protected stent treatment of high-risk patients does not increase the risk of complications. In our registry, stenting was performed electively as an alternative to endarterectomy.23 Thus, the indications were not limited to patients at high surgical risk, such as those with contralateral carotid occlusion, restenosis after endarterectomy, age 80 years, or patients who had severe concomitant cardiovascular or pulmonary disease. Our registry included patients who were suitable candidates for endarterectomy, as well as patients who were at high risk for endarterectomy. Nevertheless, the risk of periprocedural complications was low, and similar to results in surgical registries with more stringent inclusion criteria. 16, 21, 22 The clinical equipoise of the surgical and percutaneous approaches has been addressed in two randomized trials comparing endarterctomy with carotid ar.
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