I am intrigued by the article written by Dr. Kim and his colleagues on the factors that may influence carotid disease outcomes beyond symptoms and the degree of stenosis. There are several anatomical findings that are reported to result in worse outcomes with carotid stenting as I report in my May editorial. Do the readers believe that these findings will be a long-term barrier to carotid intervention or simply another factor requiring pretreatment or different device selection? It is somewhat perplexing to me that stenting gained equipoise in the CREST and ACT 1 trials despite these factors not being considered in the enrollment for the trials. Carotid pathology and correlated outcomes are among the most difficult to assess in all of vascular medicine in my opinion. Will these newer reported factors give us the extra insight needed?
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