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6% to 18.7%; p?RhoC registry data can provide a picture of current practice in the real world. Variability in carotid practice found in the VASCUNET registry is improbably related to difference in prevalence and characteristics of patients with the disease since data were recorded through the same geographic area and ethnicity groups and only in part can reflect lack of adherence to established carotid guidelines since most of the procedures in each country were performed according to European recommendations (from 70.3% to 100%; overall adherence 92.3%).1 More likely, the lack of a uniformed practice may be related to weakness in the current evidence in management of carotid disease. Despite multiple randomized clinical trials (RCT) and multiple guidelines published, carotid stenosis is still a largely unknown disease with many controversial issues. There are only few strong certainties (CEA is effective for recurrent stroke prevention in symptomatic severe carotid http://www.selleckchem.com/products/epacadostat-incb024360.html stenosis) but more unclear features in carotid related stroke for which the evidence of benefit from an intervention is weak and the strength or recommendations for management of carotid stenosis is low, as outlined in the following points: ? One controversial field is the use of interventional therapy for asymptomatic disease: although two RCTs observed that CEA conferred a significant benefit over medical therapy alone, the benefit was small, never balanced with current medical therapy advancements, and failed to achieve the level of multidisciplinary consensus accorded to RCTs for symptomatic carotid stenosis because the overall risk of stroke for patients with asymptomatic carotid disease is low. click here Opposite of CAS, CEA is today recognized a safe procedure as confirmed by the VASCUNET registry data showing very low periprocedural risks with narrow ranges by country: 2.3% in symptomatic (from 0.9% to 3.8%) and 0.9% in asymptomatic (from 0.5% to 2.7%).1 However, the main goal of any carotid procedure is the prevention of stroke. As a preventive strategy, the lack of complication must not translate in acquisition of benefit for the patient if there is no scientific proof of this efficacy point. Data from VASCUNET provide us with valuable lessons. Adherence to guidelines and quality control methods for practice are essential to uniform the management of carotid stenosis among different countries.