How to optimize brain safety with CAS and CEA

The prevention of hemodynamic and embolic neurological events has always been the main aim of carotid stenosis treatment. Today, macro- and microembolism prevention is considered the goal of both symptomatic and asymptomatic carotid plaque treatment. According to the recent literature, brain ischemic lesions can also occur in patients with clinically-silent or asymptomatic carotid atherosclerotic disease. For this reason, the treatment of high-grade asymptomatic stenosis is still recommended in most patients. However, there is still no consensus on the definition of the relation between neurocognitive performance and carotid revascularization procedures. Therefore, since it is virtually impossible to fully understand the relevance of every single microembolic lesion and its potential to trigger neurocognitive dysfunction, due to the plasticity of human brain, every effort should be made in order to avoid lesions, unless we are able to assess and classify them exactly.