Consecutive patient who underwent CAS were retrospectively analyzed from January 2008 to December 2019. Patients demographics, procedural techniques and perioperative events were captured. Outcome was measured using modified ranking scale (mRS).

176 patients with baseline mRS 0.511±1.02 and 70% or higher carotid artery stenosis (74% symptomatic; stroke 35.25%, TIA 38.85%) by NASCET and underwent CAS with loading 300 mg of clopidrogel and 324 mg chewable aspirin at least 2 hours prior to the procedure; median age 69 (39-91) female 30.7% and 95% was hypertensive. Distal embolic protection device (DPD) was used in 69% and 41% didn’t receive DPD due to the tortuosity or critical stenosis not allowing DPD. Noncooperation leading to CEA in one.  Perioperative events in 3.4% (6) compared to CREST 7.2%; CIE as TIA was observed in 2 cases (1.2%) compared to CREST 4.2%, both were in symptomatic cases. Instent thrombosis without stroke developed in one which was corrected by using intraarterial integrilin, angioplasty and deploying a second stent. Symptomatic groin complications in 2 (1.2%); closure device related ischemic leg in 1 who required repair and achieved mRS1 in 90 days and other retroperitoneal hemorrhage.  All asymptomatic patients achieved their baseline mRS in 30 days and 90 days. 

Loading dose of aspirin and clopidogrel prior to CAS are associated with a lower incidence of CIE compared to the historical CREST trial. Therefore, this strategy could be adopted prior to the CAS. Further studies are required.