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2, 95% CI 1.2-3.79) found in patients with asymptomatic carotid astenosis who had a history of contralateral TIAs at least 6 months prior to admission to the ACSRS natural history study.39 We also found differences in correlations between the type of symptomatology. In general TIA patients had a lower correlation between sides compared with AF and stroke patients. This follows the previous studies that found that plaques from TIA patients remain unstable over a longer period of time and do not remodel quickly.25, 26?and?30 This could be explained by the fact that patients tend to have multiple TIAs, which leads to instability over a longer period of time.31 It is important to note that treatment with certain medications, such as statins Bay 11-7085 could alter plaque morphology. Indeed, it has been shown that statin treatment causes a decrease in plaque volume and lipid core size, while increasing fibrous tissue content.32?and?33 However, in our population presumably the effect of statins would be similar on both plaques. Nevertheless, we have adjusted for statin use and approximately www.selleck.co.jp/products/z-vad-fmk.html 70% of our population were taking statins. We performed a sub-analysis to determine if correspondence of imaging features was dependent on the degree of contralateral stenosis. We found significantly greater correlations in patients with hemodynamically significant (>50%) contralateral stenosis. However, it is striking that even small contralateral plaques (http://www.selleck.co.jp/products/Everolimus(RAD001).html plaque should likely be monitored more closely and perhaps treated more aggressively using medical or surgical interventions, particularly when the contralateral plaque causes hemodynamically significant stenosis. Indeed aggressive medical treatment with high-dose atorvastatin in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial was shown to decrease the risk of cerebrovascular and cardiovascular events in patients with carotid stenosis.35?and?36 Furthermore, carotid intima-media thickness was reduced by aggressive lipid-lowering treatment to below 1.8?mmol/L (70?mg/dL).37 There are limitations to this study. Our study was cross-sectional; longitudinal data would be important to examine the progression of the contralateral plaques and if the surgical plaque features can predict the risk of development of unstable contralateral plaques or development of symptomatology. Although we did recruit significantly more patients than previous studies, we still did not have enough power to detect statistically significant differences in the time to ultrasound analyses.