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587, 612, 638, 674, 719, 1172, 1393, 1417, 1426, 1438, 2064], 'with': [201, 287, 292, 307, 335, 377, 437, 465, 542, 544, 590, 641, 824, 953, 1047, 1057, 1131, 1175, 1179, 1202, 1241, 1315, 1335, 1342, 1397, 1466, 1734, 1738, 1814, 1922, 2169], 'either': [202, 1165], 'symptomatic': [203, 293, 438, 803, 819, 825, 880, 1221, 1739, 1815, 1878], 'or': [204, 294, 319, 486, 505, 572, 625, 1020, 1111, 1292, 1378, 1498, 2081], 'asymptomatic': [205, 295, 821, 857, 882, 1090, 1251, 1317, 1339, 2084, 2422], 'carotid': [206, 215, 225, 296, 433, 439, 723, 826, 836, 851, 864, 904, 950, 1091, 1222, 1293, 1318, 1336, 1456, 1467, 1740, 1817, 1875, 2126, 2133, 2201, 2278, 2322, 2423, 2500], 'artery': [207, 216, 297, 440, 1731, 2197, 2202, 2279, 2501, 2535], 'disease.': [208], 'In': [209, 631, 868, 993], 'recent': [210, 1024], 'years,': [211], 'advent': [213], 'stenting': [217, 1294, 1732, 1811, 1934, 2019, 2127, 2137, 2168, 2203], '(CAS)': [218], 'has': [219, 1053], 'provided': [220, 935], 'alternative': 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817], 'myocardial': [273, 2058, 2319], 'infarction': [274, 2059, 2124, 2320], '(MI).6The': [275], 'landmark': [276], 'CREST': [277, 398, 476, 815, 1141, 1353, 1390, 1996, 2121], '(Carotid': [278], 'Endarterectomy': [280, 1809, 1930, 2328, 2367, 2471], 'versus': [281, 358, 374, 387, 929, 987, 1078, 1150, 1810, 1874, 1935, 1999, 2136, 2199, 2329], 'Stenting': [282, 1727, 1744, 1919, 1998, 2330, 2473], 'Trial)': [283], 'directly': [284], 'compared': [285, 464, 525, 1178, 1733], 'among': [289, 1683], '2502': [290], 'disease': [298, 827, 852, 1019, 1630], 'no': [301, 378, 545], 'difference': [302, 380], 'between': [303, 384, 922], 'regards': [308], 'composite': [311], 'mortality,': [316, 913], 'stroke,': [317, 1379], 'MI,': [318], 'subsequent': [320], 'ipsilateral': [321, 1259], 'within': [323], '4': [324, 1012], 'years': [325, 515, 1013], 'randomization': [327], '(7.2%': [328], '6.8%,': [330], 'respectively;': [331], 'hazard': [332, 635, 1173], 'ratio': [333], '[HR]': [334], 'stenting,': [336, 2080], '1.11;': [337], '95%': [338, 563, 569, 578, 603, 628, 652, 662, 1083], 'CI,': [339, 564, 570, 579, 604, 629, 653, 663, 1084], '0.81–1.51;': [340], 'P=0.51).7': [341], 'Among': [342], 'individual': [343], 'points,': [345], 'undergoing': [347, 363, 722], 'were': [349, 365, 790, 873], 'at': [350, 366, 907, 1011, 1926], 'higher': [352, 368, 554, 1204, 1392, 1415], 'periprocedural': [355, 371, 406, 414, 484, 488, 546, 560, 566, 592, 623, 643, 676, 706, 743, 760, 901, 927, 931, 978, 1099, 1176, 1180, 1207, 1376, 1398, 1433], 'MI': [356, 415, 567, 644, 764, 997, 1010, 1136, 1177, 1377, 1401, 1419], '(2.3%': [357], '1.1%;': [359], 'P=0.03),': [360], 'whereas': [361], '(4.1%': [373], '2.3%;': [375], 'P=0.01)': [376], 'significant': [379], 'overall': [382, 1096, 1460], 'groups': [385], '(0.7%': [386], '0.3%;': [388], 'P=0.18).': [389], 'An': [390], 'editorial': [391], 'accompanied': [393], 'publication': [395, 2511], 'noted': [400], 'health': [403], 'consequences': [404], 'are': [408, 728, 784, 906, 977, 1218, 1408, 1491], 'likely': [409, 884], 'larger': [410], 'than': [411, 841, 1070], 'and,': [416], 'therefore,': [417], 'absence': [420, 1237], 'long-term': [422, 469, 537, 550, 586, 637, 718, 737, 912, 1171, 1383, 1386, 2063], 'data,': [423], 'concluded': [424], 'should': [427, 746, 1447], 'remain': [428], 'preferred': [430, 1278], 'disease.8In': [441], 'this': [442, 869, 893, 937, 964, 1159, 1183, 1324, 1489], 'issue': [443], 'Circulation:': [445], 'Outcomes,': [449], 'al9': [452], 'shed': [453], 'new': [454, 733], 'light': [455], 'on': [456, 666, 1168, 1269, 1373], 'complex': [458], 'risk-benefit': [459, 861], 'profile': [460, 862], 'reporting': [468], 'outcomes': [470], 'enrolled': [473], 'according': [478], 'whether': [480, 619, 1290], 'experienced': [482], 'MI.9': [489], 'The': [490, 702, 756, 847, 961, 1042, 1280, 1404, 2362], 'authors': [491, 524, 670, 789, 872], 'conducted': [492], 'per-protocol': [494], 'analysis': [495, 995, 1748], '2242': [497], 'who': [499, 557, 741, 899, 924], 'received': [500], 'assigned': [502, 806], 'treatment': [503, 2002], '(CEA': [504], 'CAS)': [506], 'followed': [508], 'them': [509, 957], 'median': [512], '7.5': [514], '(maximum': [516], 'follow-up': [517, 783, 1321, 1387], '10': [518, 700], 'years).': [519, 540], 'Within': [520], 'group,': [522], 'both': [530, 818], 'short-term': [533, 715], '(0–90': [534], 'days)': [535], '(91': [538], 'days–10': [539], 'Compared': [541], 'complications,': [547], 'was': [552, 594, 613, 645, 767, 1014, 1129], 'significantly': [553], 'had': [558, 621, 1370], '(HR=1.74;': [562], '1.21–2.50),': [565], '(HR=3.61;': [568], '2.28–5.73),': [571], 'biomarker': [574], 'only': [575, 595, 710, 795, 1006, 1247], '(HR=2.04;': [577], '1.09–3.83).': [580], 'increased': [583, 909], 'confined': [596], 'first': [599], '90': [600, 607, 649, 659, 695], 'days': [601, 650, 660, 696], '(HR=14.41;': [602], '5.33–38.94).': [605], 'After': [606], 'days,': [608], 'similar': [614], 'regardless': [617], 'they': [620, 745], '(HR=1.4;': [627], '0.93–2.10)': [630], 'contrast,': [632], 'excess': [634], 'high': [646, 830, 1230, 1436], '(HR=8.4;': [651], '1.86–36.2)': [654], 'sustained': [656, 1170, 1423], 'even': [657], 'after': [658, 675, 694, 903, 2125, 2321], '(HR=3.4;': [661], '2.09–5.53).': [664], 'Based': [665, 1167], 'these': [667, 1216, 1440, 1445], 'findings,': [668], 'conclude': [671, 1190], 'late': [673], 'largely': [679], 'driven': [680], '90-day': [682], 'neurological': [683], 'events,': [684, 744, 1399], 'while': [685, 1418], 'cardiac': [686], 'events': [687, 707, 979, 1434], 'confer': [688], 'continuous': [690], 'extend': [698], 'years.': [701], 'efforts': [703], 'reduce': [705, 711], 'may': [708, 1030, 1186, 1261, 1275, 1368], 'but': [716], 'revascularization.Although': [724], 'above': [726], 'findings': [727, 962, 1157, 1217, 1446], 'noteworthy': [729], 'provide': [731], 'important': [732, 941, 971], 'information': [734], 'about': [735, 772], 'trajectory': [738], 'experience': [742, 900, 925], 'interpreted': [748], 'context': [751, 1452], 'following': [754], 'limitations.': [755], 'absolute': [757], '(3%)': [762], '(2.5%': [765, 1077], 'overall)': [766], 'relatively': [768], 'low.': [769], 'Moreover,': [770], 'data': [771, 934, 1254, 1322, 1388], 'management': [773, 843, 853, 1246, 1272, 2420], 'cardiovascular': [775, 1018, 1462], 'including': [777, 1400], 'use': [778, 1043, 1112], 'coronary': [780], 'during': [782, 1361], 'described,': [786], 'able': [791], 'adjust': [793], 'limited': [797, 1242], 'number': [798, 969], 'confounders': [800], '(age,': [801], 'sex,': [802], 'status,': [804], 'treatment)': [807], 'their': [809, 877], 'Cox': [810], 'models.': [811], 'Most': [812], 'importantly,': [813], 'patients.': [822, 846], 'have': [828, 1369], 'stroke,4,5': [834], 'more': [839], 'medical': [842, 1245, 1271, 1298, 1304, 1344, 2419], 'such': [845], 'main': [848, 890], 'debate': [849], 'around': [850], 'exists': [854], 'population,10': [858], 'where': [859], 'remains': [866], 'unclear.': [867], 'study,': [870, 1184], 'unable': [874], 'separate': [876], 'results': [878, 1056, 1866, 2130, 2370], 'into': [879], 'subgroups': [883], 'given': [885, 1210], 'small': [887], 'sample': [888], 'size.The': [889], 'takeaway': [891], 'from': [892, 1158, 1323, 1389, 1636, 1867, 2131], 'study': [894, 938, 965, 1160, 1350, 1679], 'although': [897], 'complications': [902, 1039], 'temporal': [915], 'pattern': [916], 'different': [921, 1409], 'MI.': [932, 1208], 'Long-term': [933, 1320], 'will': [939, 1288], 'clinicians': [943], 'discuss': [945], 'risks': [946, 2061], 'benefits': [948], 'strategies': [952, 1029], 'engage': [956], 'shared-decision': [959], 'making.': [960], 'raise': [967], 'questions.': [972], 'First,': [973], 'what': [975], 'extent': [976], 'related': [980], 'patient': [982, 1087, 1162], 'comorbidities': [983], 'underlying': [985], 'illness': [986], 'because': [988, 1197], 'itself?': [992], 'multivariable': [994], 'CREST,': [1000], 'Blackshear': [1001, 1986, 2035, 2095, 2310], 'al11': [1003], 'showed': [1004], 'independent': [1007], 'predictor': [1008], 'history': [1015], 'prior': [1017], 'surgery': [1021, 1092, 1239], '(HR=2.2).': [1022], 'Likewise,': [1023], 'studies': [1025], 'suggest': [1026, 1255], 'innovative': [1028], 'successful': [1032], 'perioperative': [1038], 'especially': [1040], 'stroke.': [1041, 1403], 'transcarotid': [1045, 2167], 'flow': [1048, 2171], 'reversal': [1049], 'embolic': [1051, 1109], 'protection': [1052], 'shown': [1054], 'promising': [1055], 'low-stroke': [1058], '(1.4%)': [1060], 'safety': [1063], 'efficacy': [1065], 'trial12': [1066], 'lower': [1068, 1133], 'transfemoral': [1071, 2200], 'registry': [1076], '1.7%;': [1079], 'odds': [1080], 'ratio,': [1081], '1.8;': [1082], '0.9–3.6).13': [1085], 'Appropriate': [1086], 'selection': [1088, 1163], 'can': [1093], 'help': [1094, 1328], 'decrease': [1095], 'burden': [1097], 'using': [1102], 'techniques': [1103, 1124], 'like': [1104], 'transcranial': [1105], 'doppler': [1106], 'identify': [1108, 1117, 2282], 'phenomenon14': [1110], 'advanced': [1114], 'imaging': [1115, 2280], 'vulnerable': [1118, 2284], 'plaques.15': [1119], 'Use': [1120], 'regional': [1122], 'anesthetic': [1123, 1149], 'instead': [1125], 'general': [1127], 'anesthesia': [1128], 'associated': [1130, 1201], 'comparable': [1143], '(1.8%': [1146], 'CEA-regional': [1148], '1.7%': [1151], 'CAS).16': [1152], 'Second,': [1153], 'how': [1154], 'do': [1155], 'inform': [1161], 'procedure?': [1166], 'seen': [1174], 'it': [1185], 'tempting': [1188], 'preferable': [1194], 'CEA,': [1196], 'latter': [1199], 'heterogeneity': [1212], 'population,': [1215], 'speculative.': [1219], 'For': [1220], 'stenosis,': [1223], 'poststroke': [1233], 'period': [1234], '(≈25%),17': [1240], 'role': [1243], 'approach.': [1248], 'patients,': [1252, 1287, 1441], 'contemporary': [1253, 1296], 'annual': [1256], 'rate': [1257], 'low': [1264, 1430], '0.5': [1266], '1%': [1268], 'best': [1270], 'hence': [1274], 'option.10': [1279], 'CREST-2': [1281, 2413, 2428], 'trial,': [1282], 'currently': [1285], 'enrolling': [1286], 'test': [1289], 'plus': [1295], 'intensive': [1297, 1303, 1343], 'therapy': [1299, 1305], 'alone': [1306], 'prevention': [1310], 'high-grade': [1316], 'stenosis.18': [1319], 'would': [1326], 'ascertain': [1329], 'if': [1330], 'there': [1331], 'survival': [1333, 1407], 'advantage': [1334], 'managed': [1341], 'therapy.': [1345], 'Furthermore,': [1346], '2': [1347], '3': [1349], 'participants': [1351], 'achieve': [1356], 'optimal': [1357], 'factor': [1359], 'control': [1360], 'course': [1363], 'impact': [1372], 'well': [1381], 'mortality.19In': [1384], 'conclusion,': [1385], 'shows': [1391], 'trajectories': [1405], 'portends': [1413], 'early': [1416], 'contributes': [1420], 'long-term.': [1427], 'Given': [1428], 'incidence': [1431, 1681], 'background': [1437], 'significance': [1443], 'taken': [1449], 'indication': [1454], 'surgery,': [1457], 'symptomatology,': [1458], 'baseline': [1461], 'stenosis.DisclosuresDr.': [1468], 'supported': [1471, 1479], 'NIH/NIA': [1473, 1481], 'grant': [1474], '5R03AG050930;': [1475], 'Dr.': [1476], 'grants': [1482], '5K08HL122527-05': [1483], '1I21HX002365-01A1.FootnotesThe': [1485], 'opinions': [1486], 'expressed': [1487], 'article': [1490], 'necessarily': [1493], 'those': [1494], 'editors': [1497], 'American': [1501, 1620, 1638, 2364, 2524], 'Heart': [1502, 1621, 1629, 1639, 2477, 2525], 'Association.https://www.ahajournals.org/journal/circoutcomesShipra': [1503], 'protected]eduReferences1.': [1528], 'Benjamin': [1529], 'EJ,': [1530], 'Blaha': [1531], 'MJ,': [1532, 1587], 'Chiuve': [1533], 'SE,': [1534, 1557, 2455], 'Cushman': [1535], 'M,': [1536, 1547, 1589, 1774, 1796, 1838, 1840, 2228, 2232, 2307, 2343, 2408, 2457], 'Das': [1537], 'SR,': [1538], 'Deo': [1539], 'R,': [1540, 1657, 1665, 1856, 2230], 'de': [1541, 1704, 2264], 'Ferranti': [1542], 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