The aim of the present study was to investigate the autophagic me

The aim of the present study was to investigate the autophagic mechanisms participating in traumatic brain injury. The autophagy inhibitors 3-methyladenine (3-MA) and bafliomycin A1 (BFA) were administered with a single i.c.v. injection before TBI. We first examined the protein levels of Beclin-1 and LC3 II, which have been found to promote autophagy previously. Immunoblotting analysis showed that 3-MA pretreatment reduced post-TBI Beclin-1 and LC3-II levels, and maintained p62/SQSTM1 (p62) levels. In addition, double immunolabeling showed that the increased punctate LC3-II dots colocalizing

with Propidium Iodide (PO-stained nuclei at 24 h after injury, were partially inhibited check details by 3-MA pretreatment. Furthermore, inhibition of autophagy could reduce TBI-induced cell injury assessed with i.p. injection of PI and lesion volume, and attenuate behavioral outcome evaluated by motor test and Morris water maze. The neuroprotective effects were associated with an inhibition on TBI-induced up-regulation of LC3, Beclin-1, cathepsin B, caspase-3 and the Beclin-1/Bcl-2 ratio. Taken together, these data

imply that the autophagy pathway is involved in the pathophysiologic responses after TBI, and inhibition of this pathway may help attenuate traumatic damage and functional outcome deficits. (C) 2011 IBRO. Published by Elsevier Ltd. All rights reserved.”
“Patients receiving hemodialysis have high rates of cardiovascular morbidity and mortality that may be related to the hemodynamic effects of rapid ultrafiltration. Here we tested whether higher dialytic ultrafiltration rates are associated with greater all-cause and cardiovascular this website mortality, and hospitalization

for cardiovascular disease. We used data from the Hemodialysis Study, an almost-7-year randomized clinical trial of 1846 patients receiving thrice-weekly chronic dialysis. The ultrafiltration rates were divided into three categories: up to 10 ml/h/kg, 10-13 ml/h/kg, and over 13 ml/h/kg. Compared to ultrafiltration rates in the lowest group, rates in the highest were significantly associated with increased all-cause and cardiovascular-related mortality with adjusted hazard ratios of 1.59 and 1.71, respectively. Microtubule Associated Overall, ultrafiltration rates between 10-13 ml/h/kg were not associated with all-cause or cardiovascular mortality; however, they were significantly associated among participants with congestive heart failure. Cubic spline interpolation suggested that the risk of all-cause and cardiovascular mortality began to increase at ultrafiltration rates over 10 ml/h/kg regardless of the status of congestive heart failure. Hence, higher ultrafiltration rates in hemodialysis patients are associated with a greater risk of all-cause and cardiovascular death. Kidney International (2011) 79, 250-257; doi:10.1038/ki.2010.383; published online 6 October 2010″
“Psychological stress elicits increases in sympathetic activity accompanied by a marked cardiovascular response.

Cross-sentential referential dependencies are disrupted when the

Cross-sentential referential dependencies are disrupted when the antecedent for a pronoun is embedded in a sentence introducing hypothetical entities (e.g. ‘John is considering writing a novel. It ends quite abruptly’). An earlier event-related potential reading study showed such disruptions yielded a P600-like frontal positivity. Here we replicate this effect using

auditorily presented sentences and discuss the implications for our understanding of discourse-level language processing. NeuroReport 21:791-795 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.”
“Objectives: The pivotal trial of the Talent enhanced Low Profile System (eLPS; Medtronic Vascular, Santa Rosa, Calif) stent graft evaluated short and long-term safety and efficacy check details of endovascular aneurysm repair

(EVAR). These data and a confirmatory group assessing the performance of the CoilTrac delivery system supported the United States premarket approval application for the device.

Methods: The pivotal trial was a prospective, nonrandomized study conducted at 13 sites from February 2002 to April 2003. The study group (n = 166) underwent EVAR using the Talent eLPS stent graft. The control group (n = 243) underwent open surgical AAA repair. Data for this group were obtained from the Society for Vascular Surgery Endovascular AAA Surgical Controls project. Outcomes were compared at 30 days and 12 months. Additional 5-year follow-up was obtained for the eLPS group. A single-center cohort selleck kinase inhibitor of 137 patients was the confirmatory group

for the assessment of the clinical performance of the CoilTrac delivery system, with analysis of outcomes :530 days from the procedure.

Results: AAA anatomy with neck length as short as 3 film and maximum neck diameter of 32 mm were included in the eLPS group. EVAR was superior to open repair for periprocedural outcomes, including mean procedure duration (167.3 vs 196.4 minutes, P < .001), blood transfusion (18.2% vs 56.8%, P < .001), median intensive care unit stay (19.3 vs 74.3 hours, P < .001), and mean hospital stay (3.6 vs 8.2 days, P < .001). Freedom from major adverse events was 89.2% for EVAR at 30 days vs 44.0% 3-oxoacyl-(acyl-carrier-protein) reductase (P < .001) and 81.3% vs 42.4% at 1 year (P < .001.). Freedom from all-cause mortality and aneurysm-related mortality (ARM) was 93.7% and 98.2% for EVAR vs 92.4% and 96.7% for the controls. Through 5 years for the EVAR group, rates of freedom from all-cause mortality, ARM, aneurysm rupture, and conversion to surgery were 69.8%, 96.5%, 98.2%, and 99.1%, respectively, with one conversion to surgery, 25 secondary reinterventions,and five site-reported instances of stent graft migration. The technical success rate for the CoilTrac confirmatory, group was 100%, with no aneurysm rupture or conversion to open repair at 30 days. The 30-day all-cause mortality rate was 1.5% (2 of 137).

Conclusions.

On PN47, there were increases in the number of TUNEL+ cells in mo

On PN47, there were increases in the number of TUNEL+ cells in most hippocampal regions of both ETOH and NIC groups. In the NIC+ETOH group there were less severe effects. These results were paralleled by reductions in neuronal and glial cells densities for all treatment groups. In contrast, on PN50, ethanol and/or nicotine withdrawal were associated with compensatory

reductions in TUNEL+ cells in all hippocampal regions. These results were paralleled by a reversal of effects on neuronal and glial densities so that there were no longer differences between groups. www.selleckchem.com/products/nu7441.html There were no effects on region thicknesses. These results suggest that deleterious effects of nicotine and/or ethanol are reversed during prolonged withdrawal. (C) 2010 IBRO. Published by Elsevier Ltd. All rights reserved.”
“The protective effect of an iridoid catalpol extracted and purified from the traditional Chinese medicinal herb Rehmannia glutinosa find more on the neuronal degeneration of nigral-striatal dopaminergic pathway was studied in a chronic 1-methyl-4-phenyl-1,2,3,4-tetrahydropyridine (MPTP)/probenecid C57BL/6 mouse model and in 1-methyl-4-Phenylpyridimium (MPP(+)) intoxicated cultured mesencephalic neurons. Rotarod performance revealed that the locomotor ability of mice was significantly impaired after completion of model production and maintained thereafter for at least 4 weeks. Catelpol orally administered for 8 weeks (starting from the second week of model

production) dose dependently improved the locomotor ability. HPLC revealed that catalpol significantly elevated striatal dopamine levels without changing the metabolite/dopamine ratios. Nor did it bind to dopamine receptors. Therefore it is unlikely that catalpol resembles any of the known compounds for treating Parkinsonism. Instead, catalpol dose dependently raised the tyrosine hydroxylase (TH) neuron number in substantia nigra pars compacta (SNpc), the striatal dopamine transporter (DAT) density and the striatal glial cell derived neurotrophic factor (GDNF) protein level. Linear regression Lonafarnib cost revealed that both the TH neuron number and DAT density were positively correlated

to the GDNF level. In the cultured mesencephalic neurons, MPP(+) decreased the dopaminergic neuron number and shortened the neurite length, whereas catalpol showed protective effect dose dependently. Furthermore, the expression of GDNF mRNA was up-regulated by catalpol to a peak nearly double of normal control in neurons intoxicated with MPP(+) for 24 h but not in normal neurons. The GDNF receptor tyrosine kinase RET inhibitor 4-amino-5-(4-methyphenyl)-7-(t-butyl)-pyrazolo-(3,4-d)pyrimidine (PP1) abolished the protective effect of catalpol either partially (TH) positive neuron number) or completely (neurite length). Taken together, catalpol improves locomotor ability by attenuating the neuronal degeneration of nigral-striatal dopaminergic pathway, and this attenuation is at least partially through elevating the striatal GDNF expression.

Mean Numeric Pain Intensity Scale was 1 4 points (range 0 to 4)

Mean Numeric Pain Intensity Scale was 1.4 points (range 0 to 4). On the Simple Descriptive Pain Intensity Scale 4 patients (36.3%) reported no pain, 5 (45.5%) reported mild pain and 2 (18.2%) reported moderate pain. Discharge from the hospital was possible for all patients after 6 hours. All transrectal ultrasound performed after 7 days excluded balloon migrations.

Conclusions: Transrectal ultrasound guided ProACT system implantation with the patient under local

anesthesia only is feasible, safe, well tolerated and may be performed as a day surgery procedure.”
“This study was carried out to investigate the long-term effects of chronic neonatal antagonism of N-methyl-D-aspartate (NMDA) receptors, a subtype of glutamate receptors, on working memory. Rats were tested on the delayed nonmatching-to-position task in adulthood after CFTRinh-172 repeated treatment of a noncompetitive NMDA antagonist MK-801 in postnatal days 7-20. As a result, this treatment led to Selleckchem Poziotinib deficits in learning and/or performance of delayed non matching-to-position responses, suggesting that chronic neo-natal NMDA antagonism persistently impairs working memory. Furthermore, it decreased body and brain weight, and induced stereotyped head-rotation behavior. As working memory deficits are shown in several mental disorders such as schizophrenia

and developmental disorders, rats with chronic neonatal NMDA antagonism might be useful for a better understanding of these disorders.”
“Peripheral action of p-opioid receptor agonist inhibits mechanical allodynia in mice with

herpetic pain. Mechanical allodynia is mainly mediated by A beta fibers, whereas mu-opioid receptors are present dipyridamole in C and A delta fibers. This study was conducted to address this discrepancy. Neonatal capsaicin treatment, which almost abolished aversive response to capsaicin, did not affect herpetic allodynia and antiallodynic effect of local injection of morphine. Although mu-opioid receptor was chiefly expressed in small-sized and medium-sized sensory neurons in naive mice, it was induced in large sensory neurons in mice with herpetic pain. Viral propagation in the sensory ganglion may induce mu-opioid receptor expression in A beta fibers, which may be responsible for the inhibitory action of local opioids on mechanical allodynia in mice with herpetic pain.”
“Purpose: Shorter urethral sphincter length on preoperative endorectal magnetic resonance imaging has been associated with an increased risk of postoperative urinary incontinence as well as longer time to achieve continence. We determined that our techniques of anatomical reconstruction for restoring the continence mechanism could markedly improve continence outcomes, especially in patients with a shorter urethral sphincter.

This study explored the value of baseline factors

to esti

This study explored the value of baseline factors

to estimate the likelihood of survival to 2 years for the trial cohort (Cox model) and for individual BASIL trial patients (Weibull model) as an aid to clinical decision making.

Methods: Of 452 patients presenting to 27 United Kingdom hospitals, 228 were randomly assigned to a BSX-first and 224 to a BAP-first revascularization strategy. Patients were monitored for at least 3 years. Baseline factors affecting the survival of the Repotrectinib purchase entire cohort were examined with a multivariate Cox model. The chances of survival at 1 and 2 years for patients with given baseline characteristics were estimated with a Weibull parametric model.

Results: At the end of follow-up, 172 patients (38%) were alive without major limb amputation of the trial leg, and 202 (45%) were alive. Baseline factors that were significant in the Cox model were BASIL randomization stratification group, below knee Bollinger angiogram score, body mass

index, age, diabetes, creatinine level, and smoking status. Using these factors to define five equally sized groups, we identified patients with 2-year survival rates of 50% to 90%. The factors that contributed to the Weibull predictive model were age, presence of tissue loss, serum creatinine, number of ankle pressure measurements Geneticin cost detectable, maximum ankle pressure measured, a history of myocardial infarction or angina, a history of stroke or transient ischemia attack, below knee Bollinger angiogram score, body mass

index, and smoking status.

Conclusions: Patients in the BASIL trial were Sodium butyrate at high risk of amputation and death regardless of revascularization strategy. However, baseline factors can be used to stratify those risks. Furthermore, within a parametric Weibull model, certain of these factors can be used to help predict outcomes for individuals. It may thus be possible to define the clinical and anatomic (angiographic) characteristics of SLI patients who are likely and not likely to live for >2 years after intervention. Used appropriately in the context of the BASIL trial outcomes, this may aid clinical decision making regarding a BSX- or BAP-first revascularization strategy in SLI patients like those randomized in BASIL. ( J Vase Surg 2010;51:52S-68S.)”
“Recently, insulin signaling has been highlighted in the pathology of Alzheimer’s disease (AD).

Recent

evidence suggests a link between rightward deviati

Recent

evidence suggests a link between rightward deviations in number space and defective memory for both spatial and non-spatial sequences of items. Here we describe the case of a left brain-damaged patient exhibiting right-sided neglect for extrapersonal and representational space, and left-sided neglect on the mental number line. Accurate neuropsychological selleck chemicals examination revealed that the apparent left-sided neglect in the bisection of number intervals had a purely non-spatial origin and was based on mnemonic difficulties for the initial items of verbal sequences presented visually at an identical spatial position. These findings show that effective position-based verbal working memory might be crucial for numerical tasks that are usually considered to involve purely spatial representation of numerical magnitudes.

(C) 2011 Elsevier Ltd. All rights reserved.”
“Background: Heterogeneity of vascular permeability has been suggested for the coronary system. Whereas arteriolar and capillary segments are tight, plasma proteins pass readily into the interstitial space at venular sites. Fittingly, lymphatic fluid is able to coagulate. selleck screening library However, heart tissue contains high concentrations of tissue factor, presumably enabling bleeding to be stopped immediately in this vital organ. The distribution of pro- and anti-coagulatively active factors

in human heart tissue has now been determined in relation to the types of microvessels. Methods and Results: Samples of healthy explanted hearts and dilated cardiomyopathic hearts were immunohistochemically stained. Albumin was found throughout the interstitial space. Tissue factor was packed tightly around arterioles and capillaries, whereas the tissue surrounding venules and small veins was practically free of this starter of coagulation. Thrombomodulin was present at the luminal surface of all vessel segments and especially at venular endothelial cell junctions. Its product, the anticoagulant protein C, appeared only at discrete extravascular MRIP sites, mainly next to capillaries. These distribution patterns were basically identical in the healthy and diseased hearts, suggesting a general principle. Conclusions: Venular extravasation of plasma proteins probably would not bring prothrombin into intimate contact with tissue factor, avoiding interstitial coagulation in the absence of injury. Generation of activated protein C via thrombomodulin is favored in the vicinity of venular gaps, should thrombin occur inside coronary vessels. This regionalization of distribution supports the proposed physiological heterogeneity of the vascular barrier and complies with the passage of plasma proteins into the lymphatic system of the heart. Copyright (C) 2010 S.

We present our early experience with an attempt to optimize extra

We present our early experience with an attempt to optimize extracorporeal membrane oxygenation, emphasizing reduced adjunctive

mechanical ventilatory support and aggressive rehabilitation, with a goal of ambulation. This strategy has been enabled by the introduction of a dual-lumen draw and return cannula placed via the internal jugular vein.

Methods: The first 10 patients (mean age of 45.3 years, 8 male) treated with this strategy between January 1, 2009, and October 1, 2009, were retrospectively reviewed. The ambulatory extracorporeal membrane oxygenation strategy was initiated with an aim of minimal mechanical ventilation and aggressive rehabilitation. The patients were intended to be weaned from all respiratory Captisol supplier support or bridged to transplantation.

Results: The mean duration of extracorporeal membrane oxygenation was 20 (9-59) days, with average mean blood flows of 3.5 (1.6-4.9) L/min, and levels of CO(2) removal and O(2) transfer of 228 (54-570) mL/min and 127 (36-529) mL/min, respectively. Six of 10 patients were weaned from respiratory support

(N = 4) or underwent transplantation (N = 2) and survived to discharge from the hospital. The remaining 4 patients died of sepsis (N = 3) and withdrawal of care after renal failure (N = 1). Four of the 6 surviving patients were extubated and ambulatory check details while still on extracorporeal membrane oxygenation. During that time, 3 of the 4 patients exercised at the bedside, with the remaining patient able to

undergo full cardiopulmonary rehabilitation, including treadmill walking.

Conclusions: Improvements in the durability of membrane blood oxygenators and pumps have prompted renewed consideration of GPX6 extracorporeal membrane oxygenation in patients with severe lung disease. This report describes an attempt to augment extracorporeal membrane oxygenation with the goal of ambulation by minimizing mechanical ventilatory support and using aggressive in-and-out-of-bed rehabilitation. (J Thorac Cardiovasc Surg 2011; 142: 755-61)”
“Haplopappus gracilis (Nutt.) Gray, one of the five known higher plants with a chromosome number of 2n = 4, was studied from a cytological point of view. The chromosome complement of this species was characterized by means of automated karyotype analysis. Moreover, the DNA methylation pattern and fluorochrome banding were determined and compared with cytological data present in the literature. DNA methylation distribution along metaphase chromosomes involved all chromosome territories evidenced by C-banding. Other methylated bands correlated positively with aceto-orcein-positive heterochromatic portions and/or with late replicating bands and/or fluorochrome bands. Some methylated bands showed differences between homologous chromosomes. These bands belonged partly to certain heterochromatic domains and partly to intercalary sites not defined by other standard banding techniques.

This work extends the boundaries of the EPL technique for semisyn

This work extends the boundaries of the EPL technique for semisynthesis of multidomain, extracellular,

disulfide-bonded, and glycosylated proteins and highlights www.selleckchem.com/products/gkt137831.html its potential application for reconstituting entire single-pass transmembrane proteins.”
“Interleukin-1 beta (IL-1 beta) and IL-18 contribute to host defense against infection by augmenting antimicrobial properties of phagocytes and initiating Th1 and Th17 adaptive immune responses. Protein complexes called inflammasomes activate intracellular caspase-1 autocatalytically, which cleaves the inactive precursors of IL-1 beta and IL-18 into bioactive cytokines. In this review, we discuss the controversies regarding inflammasome activation and the role of the inflammasome during infection. We highlight alternative mechanisms for processing IL-1 beta and IL-18 during infection, which involve extracellular cleavage of the inactive cytokines by neutrophil-derived serine proteases or proteases released from cytotoxic T cells.”
“Purpose: Clinical and basic research data suggest that pelvic ischemia may contribute to bladder overactivity. We characterized the molecular and this website ultrastructural reactions of the chronically ischemic bladder.

Materials and Method: A model of pelvic ischemia was developed by creating iliohypogastric/pudendal arterial atherosclerosis in rabbits. At 12 weeks conscious urinary frequency was examined, bladder

blood flow was recorded and cystometrograms were done using general anesthesia. Bladder tissue was processed for molecular and ultrastructural analysis using quantitative real-time polymerase chain reaction, Western blot and transmission electron microscopy.

Results: Conscious urinary frequency and the frequency of spontaneous bladder contractions significantly increased in animals with pelvic ischemia.

Bladder ischemia up-regulated the gene and protein expression of hypoxia inducible factor-1 alpha, transforming growth factor-beta and nerve growth factor B. Vascular endothelial growth factor gene expression also increased but protein levels were unchanged. Transmission electron microscopy of ischemic bladder samples showed swollen mitochondria with degraded granules, thickened epithelium, deformed muscle fascicles, collagen deposition and impaired microvasculature with thickened intima and disrupted endothelial cell junctions. Degenerating Amisulpride axonal and Schwann cell profiles, and myelin sheath splitting around axons and Schwann cells were evident in ischemic bladders.

Conclusions: Interrupting pelvic blood flow resulted in an ischemic overactive bladder and significant increase in conscious urinary frequency. Molecular responses involving hypoxia inducible factor, transforming growth factor-beta, vascular endothelial growth factor and nerve growth factor were associated with mitochondrial injury, fibrosis, microvasculature damage and neurodegeneration. Ischemia may have a key role in bladder overactivity and lower urinary tract symptoms.

We compared add-on exenatide with glimepiride for durability of g

We compared add-on exenatide with glimepiride for durability of glycaemic control in patients with type 2 diabetes inadequately controlled by metformin

GDC-0994 alone.

Methods We did an open-label, randomised controlled trial at 128 centres in 14 countries between Sept 5, 2006, and March 29, 2011. Patients aged 18-85 years with type 2 diabetes inadequately treated by metformin were randomly assigned via a computer-generated randomisation sequence to receive exenatide twice daily or glimepiride once daily as add-on to metformin. Randomisation was stratified by predetermined categories of glycated haemoglobin (HbA(1C)) concentration. The primary outcome was time to inadequate glycaemic

control and need for alternative treatment, defined as an HbA(1c) concentration of more than 9% after the first 3 months of treatment, or more than 7% at two consecutive visits after the first 6 months. Analysis was by intention to treat. This trial is registered with EudraCT, number 2005-005448-21, and ClinicalTrials.gov, number NCT00359762.

Findings We randomly assigned 515 patients to the exenatide group and 514 to the glimepiride group, of whom 490 versus 487 were the intention-to-treat https://www.selleckchem.com/products/amg510.html population. 203 (41%) patients had treatment failure in the exenatide group compared with 262 (54%) in the glimepiride group (risk difference 12.4 [95% CI 6.2-18.6], hazard ratio 0.748 [0.623-0.899]; p=0.002). 218 (44%) of 490 patients in the exenatide group, and 150 (31%) of 487 in the glimepiride group achieved an HbA(1c) concentration of less than 7% (p<0.0001), and 140 (29%) versus 87 (18%) achieved concentrations of 6.5% and less (p=0.0001). We noted a significantly greater decrease in bodyweight in patients given Amine dehydrogenase exenatide than in those given glimepiride (p<0.0001). Five patients in each treatment group died from causes unrelated to treatment. Significantly fewer patients in the exenatide

group than in the glimepiride group reported documented symptomatic (p<0.0001), nocturnal (p=0.007), and non-nocturnal (p<0.0001) hypoglycaemia. Discontinuation because of adverse events (mainly gastrointestinal) was significantly higher (p=0.0005) in the exenatide group than in the glimepiride group in the first 6 months of treatment, but not thereafter.

Interpretation These findings provide evidence for the benefits of exenatide versus glimepiride for control of glycaemic deterioration in patients with type-2 diabetes inadequately controlled by metformin alone.”
“Astrocytes are currently studied intensively because of their now highlighted relevance as key players with neurons that modulate a wide range of central functions, from synaptic plasticity and synaptogenesis to regulation of metabolic and neuroinflammatory processes.

7% (95% confidence interval [CI], 0%-3%); patients with Spetzler-

7% (95% confidence interval [CI], 0%-3%); patients with Spetzler-Martin grade 3 to 4 AVMs in noneloquent cortex (n = 65) were treated with a surgical risk of 17% (95% CI, 10%-28%). Patients with Spetzler-Martin grade 3 to 5 AVMs in eloquent cortex (n = 168) were treated with a surgical risk of 21% (95% CI, 15%-28%). However, because 14% of patients

in this series with similar AVMs were refused surgery because of perceived surgical risk, these results are not generalizable to the population of patients with similar AVMs.

CONCLUSION: The results of this series suggest that it is reasonable to offer surgery as a preferred treatment option for Spetzler-Martin grade 1 to 2 AVMs. This study also Etomoxir datasheet reinforces the predictive value of

the Spetzler-Martin grading system, with some caveats.”
“Background Carotid artery stenting (CAS) has been advocated selleck screening library as an alternative to carotid endarterectomy (CEA) in high-risk surgical patients, including stenosis after CEA. This study compared earl), and midterm clinical outcomes for primary CAS vs; CAS for post-CEA stenosis.

Methods: This study analyzed 180 high-risk surgical patients: 68 had primary CAS (group A), and 112 had CAS for post-CEA stenosis (group B). Patients were followed-up prospectively and had duplex ultrasound imaging at 1 month and every 6 months thereafter. All patients had cerebral protection devices. Kaplan-Meier life-table analysis was used to estimate rates of freedom from stroke, stroke-free survival, >= 50% in-stent stenosis, >= 80% in-stent stenosis, and target vessel reintervention (TVR).

Results. Patients had comparable demographic and clinical characteristics. Carotid stent locations were similar. Indications for CAS were transient ischemic attacks (TIA) or stroke in 50% for group

A and 45% for group B. The mean follow-up was comparable, at 21 (range, 1-73) vs 25 (range, heptaminol 1-78) months, respectively. The technical success rate was 100%. The perioperative stroke rates and combined stroke/death/myocardial infarction (MI) rates were 7.4% for group A vs 0.9% for group B (P = .0294). No perioperative MIs occurred in either group. One death was secondary to stroke. The combined early and late stroke rates were 10.8% for group A and 1.8% for group B (P = .0275). The stroke-free rates at 1, 2, 3, and 4 years for groups A and B were 89%, 89%, 89%, and 89%; and 98%, 98%, 98%, and 98%, respectively (P = .0105). The rates of freedom from >= 50% carotid in-stent stenosis were 94%, 83%, 83%, and 66% for group A vs 96%, 91%, 83%, and 72% for group B (P = .4705). Two patients (3%) in group A and seven patients (6.3%) in group B had >= 80% in-stent stenosis (all were asymptomatic except one). The freedom from >= 80% in-stent stenosis at 1, 2, 3, and 4 years for groups A and B were 100%, 98%, 98%, and 78% vs 99%, 96%, 92%, and 87%, respectively (P = .7005).