[INTRODUCTION - Reducing the risk of embolisation during endovascular treatment of internal carotid artery stenosis is very important. The rate of embolisation is affected by the different steps of stenting manipulation. Using transcranial Doppler equipment we studied the embolic signals during the different phases of carotid dilatation and stenting. MATERIAL AND METHOD - 50 patients (33 male, 17 female; mean age 64 years) were intraproceduraly monitorized with transcranial Doppler. Predilatation was necessary in nine cases, postdilatation was performed in 39 cases. The number of emboli were measured in seven different steps of endovascular treatment of carotid stenosis. Different type of commercial available endovascular devices were used. RESULTS - Intraprocedural embolisation was observed in every case. In different phases of carotid stenting the rate of embolisation showed marked differences in each phase of carotid stenting. Crossing the stenosis with stent delivery system were accompanied by a low rate of embolism (5.3) compared to the level during stent opening (9.16) and balloon dilatation (9.96). The highest level of embolisation was observed during predilatation (15.9) without the protection of the stent. CONCLUSIONS - We detected embolisation in all of the cases, however the number of embolic signals varied in different phases of carotid artery stenting. Embolisation can be reduced if the most dangerous steps (i.e. pre- and postdilatation) are avoided. Using TCD monitorisation the physician can be informed by the degree of embolisation that may alarm the interventionalist to perform the procedure more carefully, furthermore it can be employed during the training of carotid stenting.]

[The main role of atherogenic dyslipidemia is known for decades. Several studies have proven the beneficial effect of statin therapy on cardiovascular morbidity and mortality. The following case report demonstrates the efficacy of high dose statin therapy regarding lipid goals and clinical signs. The presented 65 year-old female patient had a history of dyslipidemia and hypertension for over 15 years and positive cardiovascular family history. Carotid ultrasound examination showed 15-20% bilateral stenosis in 2008 whereas four years later, control ultrasound showed significant progression with 65% left-sided asymptomatic stenosis. At this time, LDL-cholesterol level was above the target; we managed to reach the recommended level with high-dose statin treatment in combination therapy with ezetimibe. Besides the lipid levels, regression of the carotid stenosis could be observed without statin-associated side effects.]

[PURPOSE - During the endovascular treatment of internal carotid artery stenosis, one of the most important aspects is reducing of embolic complications. Degree of embolization may be influenced by the force exerted by stent delivery systems and embolic protection devices. We assessed the force emersion produced by various devices on vessel walls and plaques. MATERIAL AND METHOD - Six different commercially available devices were investigated. The force load on vessel wall was measured in a carotid model with vessel angulations of 25, 50 and 75 degree, respectively. The IDTE 2000 CE marked measurement system was used. A transparent, flexible PVC tube was used as a model of the carotid bifurcation, which was 6 mm in width, 1.5 mm wall thickness and 12 mm length. 75-85% stenosis were created in it. The measured data were evaluated and different conclusions were drawn. RESULTS - Forces exerted on vessel walls varied widely among different stent delivery systems. The magnitude of force exertion caused by stent delivery systems significantly exceeded that caused by protecting devices. Protecting devices showed only 30% increase in vessel load at angulation of 75 degrees compared to those at 25-50 degrees. Above 50 degrees of vessel angulation the forces exerted by stent delivery systems considerably increases. CONCLUSIONS - Our results showed that selection of the most proper stent can contribute to decrease in the load of vessel wall. Protecting devices exert significantly lower forces than stent delivery systems, therefore, it seems to be a better choice to advance a protecting device before introducing a stent delivery system. If the vessel angulation exceeds 50 degrees, endarterectomy should be considered, because the vessel wall load will increase radically in that case.]