These data suggest that endarterectomy on the basis of Doppler US and CE-MRA can be considered appropriate. CEMRA was the best noninvasive imaging modality to detect plaque ulceration.

To evaluate the safety and efficacy of carotid artery stenting (CAS) performed without an embolic protection device (EPD) in a selected group of asymptomatic patients with primary internal carotid artery (ICA) stenosis or restenosis after carotid endarterectomy (CEA). Materials and Methods: Between May 2015 and May 2018, 77 patients (mean age 77 years; 60 men) underwent CAS without any embolic protection device. Forty-seven (61%) patients had primary ICA stenosis and were excluded from CEA because of high surgical risk; the other 30 (39%) patients had post-CEA restenosis (n=26) or a distal ICA flap after eversion CEA (n=4). The mean ICA stenosis was 82%. All procedures were performed from a femoral artery access. Pre-and/or postdilation were used in 64 patients. The primary outcome was the incidence of major complications (death, stroke, or myocardial infarction) during the procedure and within 30 days; the secondary outcome was the incidence of restenosis in follow-up. Results: No relevant bradycardia was encountered during CAS. The combined rate of stroke, death, or myocardial infarction at 30 days was 1.3%. The single stroke patient recovered fully after 2 months. Over a follow-up that ranged to 3 years (mean 24±18 months), no further neurological events were recorded. One (1.3%) patient had a >70% restenosis after 6 months; the lesion was dilated, successfully restoring the lumen contour. Conclusion: In our series, endovascular treatment of carotid stenosis without the use of protection devices in patients with primary stenosis or postsurgical restenosis can achieve satisfactory safety and efficacy outcomes. The choice of performing CAS without using EPDs should follow a tailored approach based on the appropriate patient anatomy and specific clinical parameters to minimize neurological complications.

84C urrently the number of aortofemoral bypasses performed for iliac occlusive arterial pathology is decreasing (1-4). The causes of this turnaround are the increase of the patients' mean age and the increased frequency of concurrent pathologies. Moreover, surgery, which for a long time has been considered as the treatment of choice for this pathology, has almost completely been replaced by less invasive methodologies such as endovascular treatments (5-9). The role of thrombolysis to treat the iliac arterial occlusive pathology on an atherosclerotic basis during endovascular surgery is controversial. Although comparing experiences is difficult, the results of pharmacologic thrombolysis to treat iliac arterial obstructions with regard to the different methodologies of treatment, to the drugs used and to other nonstandardized variables seem encouraging (8). The first experiences with fibrinolytic therapy made us think it was unlikely that thrombolytic occlusions which had been present for longer than 1-2 weeks would adequately respond to these treatments. On the contrary, it was proved that injections of streptokinase or urokinase-type plasminogen activator (uPA) through the thrombus could also cause complete fibrinolysis in chronic occlusions (8). Recent thrombi (<15 days) are more sensitive to lysis, as shown by data from post-angioplasty thrombolysis (2, 5, 10). It is also true, however, that remarkable results may be achieved by using only percutaneous treatment angioplasty (PTA) associated with the stent technique (7).The purpose of this study was to assess the possible therapeutic advantage of thrombolysis prior to recanalization of iliac occlusions with PTA and stenting. Materials and methodsWe retrospectively evaluated 28 cases of iliac occlusions treated in 26 patients (in two cases there was a re-occlusion) over a six-year period. Our cases did not have contraindications for thrombolysis. No patients were diabetic. The presumed etiologies for the iliac occlusions were plaque thrombosis for acute patients and chronic atherosclerotic disease for chronic patients. Absolute contraindications were established such as cerebrovascular event (including transient ischemic attacks within last 2 months), active bleeding diathesis, recent gastrointestinal bleeding (<10 days), neurosurgery within last 3 months, and trauma within last 3 months (10, 11); relative major contraindications were cardiopulmonary resuscitation within last 10 days, major nonvascular surgery or trauma within last 10 days, uncontrolled hypertension (180 mmHg systolic or 110 mmHg diastolic), puncture of non-compressible vessel, intracranial tumor, and eye surgery; minor contraindications were hepatic failure, particularly those with coagulopathy, bacterial endocarditis, pregnancy, and hemorrhagic retinopathy (10, 11). INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE Thrombolysis during the endovascular treatment of iliac artery occlusionsGiuseppe Taddei, Paolo Tamellini, Faccioli Niccolo, Iannello Antonio PURPOSEThe purpose of this study was to assess...