The medically treated patients' risk with high-grade ICA stenosis (Ͼ70%) for ipsilateral stroke at 2 years was higher in patients with CKD then in those with preserved renal function (31.6% vs 19.3%; P ϭ .042). Carotid endarterectomy reduced this risk by 82% and 51%, respectively. Prevention of one stroke in terms of numbers needed to treat was 10 for patients with preserved renal function. However, the number needed to treat to prevent one stroke was only four in patients with CKD. Patients with CKD had similar rates of perioperative stroke and death but higher rates of perioperative cardiac deaths than patients without CKD.Comment: Twelve years after its initial publication, the NASCET trial is still spinning off interesting-but very thinly sliced-additional pieces of salami. Patients with CKD can be inappropriately denied interventions because of perceived, but not proven, high risk. This phenomenon has been termed "renalism" (J Am Soc Nephro 2004;15:246.2468). The article is interesting because it not only reports patients with symptomatic high-grade ICA stenosis and CKD appear to drive significant benefit from endarterectomy but also raises the concept that patients with CKD, although at higher risk with certain procedures, may actually, in the long-term, derive increased benefit over those without CKD. Also, as the authors pointed out, large randomized trials should consider enrolling, rather than somewhat arbitrarily excluding, patients with CKD. CKD patients may actually derive unexpected and substantial benefit from selected procedures.

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Results: Mean uptake over the decade was 90.1%. There was a strong association between deprivation and uptake, which ranged from 79.5% in the most deprived population to 97.5% in the least deprived (P < .001). The odds of men who were least deprived attending was 10.6 times higher than those who were most deprived (P < .001). Higher uptake was observed in more rural areas (P ¼ .02). When combined in a logistic regression model, only deprivation remained significant, indicating any apparent effect of rurality was explained by deprivation. No change was observed in the mean aortic diameter of 65-year-old men or the incidence of AAA. Conclusion: HASP has a high uptake even in the most deprived and rural populations, demonstrating that programme design has overcome any potential rural disadvantage. A gradient of uptake associated with deprivation remains, although even the most deprived have an uptake of almost 80%.

The porcine heart can be used as an experimental model to design and test new devices for catheter-based composite repair of the aortic root. Nevertheless, caution is required in using devices with tailored dimensions that must be adapted to the smaller pig's root.

Objective: A daily Rapid-Access TIA Clinic was introduced in 2008, where symptomatic patients were started on 75 mg aspirin þ 40 mg simvastatin by the referring doctor, before attending the clinic. Following clinic assessment, patients with 50-99% stenoses were transferred to the vascular unit for carotid endarterectomy (CEA). In two audits (n ¼ 212 patients), the median delay from transfer to the vascular unit to undergoing CEA was 3 days, during which time 28 patients (13%) suffered recurrent neurological events. It was hypothesized that early introduction of dual antiplatelet therapy (by adding clopidogrel 75 mg once parenchymal haemorrhage was excluded in the TIA clinic) might significantly reduce recurrent events between transfer to the surgical unit and undergoing CEA.Methods: Prospective audit in 100 consecutive, recently symptomatic patients receiving dual antiplatelet therapy. Endpoints were: prevalence of recurrent events between transfer from the TIA clinic and undergoing CEA; rates of spontaneous embolization prior to undergoing CEA; and prevalence of haemorrhagi complications.Results: The median delay from symptom to CEA was 8 days (IQR 5-15). The median delay between transfer from the TIA clinic to CEA was 3 days (IQR 2-5), during which time three patients (3%) suffered recurrent TIAs. This represents a fivefold reduction compared with previous audit data (OR 4.9, 95% CI 1.5-16.6, P ¼ .01) and was matched by a fourfold reduction in the prevalence of spontaneous embolization from 39/189 (21%) previously to 5/83 (5%) in the current audit (OR 4.1, 95% CI 1.5-10.7, P ¼ .0047). The 30-day death/stroke rate was 1%. There were three haemorrhagic complications: stroke caused by haemorrhagic transformation of an infarct; exploration for neck haematoma; and debridement and skin grafting for spontaneous shin haematoma.Conclusion: Early introduction of dual antiplatelet therapy was associated with a significant reduction in recurrent neurological events and spontaneous embolization prior to CEA, without incurring a significant increase in major peri-operative bleeding complications.