***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND In primary and secondary prevention , statins significantly reduce cardiovascular and cerebrovascular events .  Pre-interventional statin medication shows a benefit in carotid artery stenosis patients treated with endarterectomy ;  however , there are few data available for patients treated with stent-angioplasty .  The aim of this study was to investigate whether pre-interventional statin therapy is associated with decreased peri-interventional risk of stroke , myocardial infa rct ion , and mortality in patients undergoing stent-angioplasty for internal carotid stenosis . METHODS Data for 344 consecutively documented patients with internal carotid artery stenosis treated with stent-angioplasty in the years 2002 - 2012 at the same stroke center were collected in a prospect ively defined data base . Risk factors , medication , and indication for therapy were documented . Univariate and multivariate analysis was performed to investigate independent reduction of peri-interventional stroke , myocardial infa rct ion , or death by statin medication prior to stent-angioplasty . RESULTS The median age was 70 years ( p25 : 63 , p75 : 76 ) , 75.5 % of patients were male , and the median stenosis was 85 % according to ECST criteria ( p25 : 80 % , p75 : 90 % ) . 20.1 % of patients had asymptomatic stenoses , and 60.2 % had statin medication before stenting . As per multivariate analysis , pre-interventional statin medication was a predictor for significant peri-interventional risk reduction regarding primary endpoint ischemic stroke , myocardial infa rct ion ( MI ) , or death ( odds ratio ( OR ) 0.31 , p = .006 ) . Statins also had a significant protective effect in secondary endpoint ischemic stroke , intracranial bleeding or death ( OR 0.39 , p = .014 ) , and ischemic stroke or myocardial infa rct ion ( OR 0.20 ; p = .002 ) . CONCLUSIONS This study shows that pre-interventional statin medication has a protective effect against peri-interventional stroke , MI , or death in patients with internal carotid artery stenosis treated with stent-angioplasty . Accordingly , statins could be considered as a st and ard pre-interventional medical therapy in carotid stenting Cerebral ischaemia , the most frequent serious complication of carotid endarterectomy ( CEA ) , usually occurs in the early postoperative period and is often the result of thromboembolism . We hypothesized that the early postoperative detection of microembolic ultrasonic signals ( MES ) with transcranial Doppler ultrasound ( TCD ) may be of value in identifying patients at risk of postoperative cerebral ischaemia and that the MES rate may be an important determinant in risk prediction . Sixty-five patients undergoing CEA were studied at intervals up to 24 h postoperatively with TCD insonation of the middle cerebral artery ipsilateral to the operation side . Study design was open and prospect i ve with blinded off-line analysis of MES counts . End-points were any focal ischaemic neurological deficit and /or death up to 30 days postoperatively . MES were detected in 69 % of cases during the first hour postoperatively with counts ranging from 0 to 212 MES/h ( means 19 MES/h ; SEM + 2- 4.5 ; median 4 MES/h ) . In seven cases ( 10.8 % ) counts were > 50 MES/h . Five of these seven cases developed ischaemic neurological deficits in the territory of the insonated middle cerebral artery during the monitoring period . The positive predictive value of counts > 50 MES/h for cerebral ischaemia was 0.71 . Frequent signals ( > 50 MES/h ) occur in approximately 10 % of cases in the early postoperative phase of CEA and are predictive for the development of ipsilateral focal cerebral ischaemia Approximately 25 % of elderly patients scheduled for carotid endarterectomy ( CEA )  develop post-operative cognitive dysfunction ( CD ) . We tested the hypothesis that the plasma levels of matrix metalloproteinase 9 ( MMP-9 ) are predictive of moderate to severe CD after CEA . A total of 73 patients were prospect ively enrolled in this Institutional Review Board-approved study . Plasma sample s were obtained at baseline and day 1 post-surgery . We measured the plasma concentrations of both MMP-9 and its inhibitor , tissue inhibitor of metalloproteinases 1 ( TIMP-1 ) . We estimated the MMP-9 activity by calculating the MMP-9:TIMP-1 ratio . The cognitive performance day 1 post-surgery was quantified with z-scores , using a control group who were undergoing spinal surgery . The criteria used to define CD was performance of > or=1.5 st and ard deviations worse than the control group ; approximately 19 % of eligible patients developed CD . Compared to patients without CD , this group had both higher total ( 81.66+/-12.25 ng/mL versus [ vs. ] 43.18+/-4.44 ng/mL , p=0.005 ) and activity ( 0.88+/-0.24 ng/mL vs. 0.54+/-0.06 ng/mL , p=0.003 ) MMP-9 levels at baseline . All of the results were adjusted for age , diabetes and neurovascular symptoms BACKGROUND This study analyzed the effect of statins on clinical outcomes after carotid endarterectomy ( CEA ) and the rate of restenosis . STUDY DESIGN We performed a retrospective analysis of prospect ively collected data on 500 consecutive CEAs followed at 1 , 6 , and 12 months and every year . RESULTS There were 299 patients on statins vs 201 without .  Combined perioperative MI/death rates were 2.7 % vs 4 % ( p = 0.416 ) and MI/stroke/death rates were 4 % vs 5 % ( p = 0.607 ) for statins vs no statins . At mean follow-up ( 27 months ) , MI , stroke , and death rates were : 9.7 % , 2.3 % , and 2.3 % vs 9 % , 2.5 % and 4.5 % ( p = 0.18 ) for statins vs no statins , respectively . Diabetic patients not on statins  had 4 times more deaths ( 8.5 % vs 2.3 % ) and twice as many strokes/deaths ( 10.2 % vs 5.3 % ) . Patients with hypercholesterolemia who were not on statins had twice as many deaths ( 4.3 % vs 2.2 % ) . Rates of freedom from stroke/MI/death at 1 , 2 , 3 , and 4 years were : 94 % , 90 % , 85 % and 77 % vs 94 % , 89 % , 85 % , and 82 % ( p = 0.87 ) for statins vs no statins , respectively . Rates of freedom from death only for patients on statins vs no statins at 1 , 2 , 3 , and 4 years were : 98 % , 98 % , 97.4 % and 97.4 % vs 98 % , 96 % , 94.8 % and 94.8 % , respectively ( p = 0.191 ) . For diabetic patients  , rates of freedom from death at 1 , 2 , 3 , and 4 years were 99 % , 99 % , 97 % , and 97 % for statins vs 97 % , 90 % , 90 % , and 90 % without statins , respectively ( p = 0.048 ) . Post-CEA restenosis rates ≥ 50 % were not significantly different between statins vs no statins ( p = 0.64 ) . CONCLUSIONS Statins significantly lowered death rates in patients with diabetes and tended to lower both death and stroke rates  in diabetic patients and patients with hypercholesterolemia . Statins had no effect on post-CEA restenosis Background and Purpose — The object of our study was to compare the effect of high-dose vs low-dose atorvastatin vs nonstatin-based treatment ( cholestyramine plus sitosterol ) on cell composition of carotid plaque . Methods — We recruited 60 hypercholesterolemic patients ( total cholesterol , 5.83 - 7.64 mmol/L ) eligible for carotid endarterectomy . Three months before surgery , patients were r and omized into 3 groups ( n=20 ) receiving atorvastatin 10 mg/day ( AT-10 ) or atorvastatin 80 mg/day ( AT-80 ) or cholestyramine 8 g/day plus sitosterol 2.5 g/day . Analysis of cell composition was performed on endarterectomy specimens . Results — The 3 treatments result ed in a significant reduction of total cholesterol and low-density lipoprotein cholesterol ( LDL-C ) , although the decrease in total cholesterol and LDL-C was of smaller magnitude in the cholestyramine plus sitosterol group . The 3 regimens did not influence the levels of inflammatory markers ( including high-sensitivity C-reactive protein ) . Macrophage content was significantly lower in the AT-10 group plaques compared to the cholestyramine plus sitosterol group . It was further reduced in the AT-80 group plaques . These differences were no longer significant after adjustment for changes in LDL-C. No difference in lymphocyte number was observed among treatments , whereas the content of smooth muscle cells was higher in the AT- 80 group . An inverse association was observed between LDL-C changes in the 3 groups and macrophage content in the plaques . Conclusions — Short-term treatment with high-dose statin is superior to a nonstatin lipid-lowering regimen in reducing the macrophage cell content within atherosclerotic lesions , but this effect was determined by the degree of LDL-C-lowering Background and Purpose — Several carotid endarterectomy r and omized , controlled trials and series have reported higher perioperative stroke and death rates for women compared with men . The potential for this same relationship with carotid artery stenting was examined in the lead-in phase of the Carotid Revascularization Endarterectomy versus Stenting Trial ( CREST ) . Methods — CREST compares efficacy of carotid endarterectomy and carotid artery stenting in preventing stroke , myocardial infa rct ion , and death in the periprocedural period and ipsilateral stroke over the follow-up period . CREST included a “ lead-in ” phase of symptomatic ( ≥50 % stenosis ) and asymptomatic ( ≥70 % stenosis ) patients . Patients were examined by a neurologist preprocedure , at 24 hours , and at 30 days . Review of stroke and death was by an independent events committee . The association of sex with periprocedural stroke and death was examined in 1564 patients undergoing carotid artery stenting ( 26.5 % symptomatic ) . Results — Women comprised 37 % of the lead-in cohort and did not differ from men by age , symptomatic status , or characteristics of the internal carotid artery . The 30-day stroke and death rate for women was 4.5 % ( 26 of 579 ; 95 % CI , 3.0 % to 6.5 % ) compared with 4.2 % ( 41 of 985 ; 95 % CI , 3.0 % to 5.6 % ) for men . The difference in stroke and death rate was not significant nor were there any significant differences by sex after adjustment for age , arterial characteristics , or cardiovascular risk factors . Conclusions — These results do not provide evidence that women have a higher carotid artery stenting stroke and death rate compared with men . The potential differential periprocedural risk by sex will be prospect ively addressed in the r and omized phase of CREST BACKGROUND Carotid endarterectomy is a low-risk treatment for carotid occlusive disease . Recent clinical trials have suggested that carotid angioplasty may be a viable alternative . One important issue that has not been evaluated is the long-term recurrent stenosis rate after either intervention . OBJECTIVE To examine the risk of recurrent stenosis after carotid endarterectomy and to provide long-term data on the durability of carotid endarterectomy . METHODS A total of 1335 sequential patients were followed up prospect ively with annual carotid ultrasonography . All patients were maintained on antiplatelet therapy , and arteriotomies were closed with a patch graft . Operations were performed under general anesthesia with electroencephalographic monitoring and selective shunting . There were no changes in surgical technique during this study . RESULTS Two-thirds of the patients were men ; the mean age was 70 years . Approximately 60 % were symptomatic . The 90-day perioperative morbidity and mortality rate was 0.9 % ( 0.4 % stroke and 0.5 % death ) . Five patients ( 0.4 % ) developed recurrent stenosis > 70 % over a mean follow-up of 15.8 years . Twelve patients ( 0.9 % ) had documentation of late stroke in the ipsilateral carotid distribution . The mean follow-up was 15.8 years . CONCLUSION Carotid endarterectomy is an extremely safe treatment for carotid 
    Output:
    
Conclusions Administration of statins before CEA is associated with lower rates of perioperative stroke and improved overall survival .