Despite having reviewed the outcomes of thousands of patients enrolled in many previous trials evaluating carotid artery stenting (CAS), the global interventional community, the FDA, and CMS continue to actively seek more data regarding the optimal strategies for todayÕs carotid artery disease patients. Many multicenter and international trials and registries are underway, and more are planned to evaluate therapeutic efficacy in a variety of patients. Clearly, it will take several years to see these trials through to fruition, but as clinical experience with carotid therapy continues to mount, our ability to evaluate everyday outcomes increases as well. With this in mind, we have asked several leading investigators to share the progress of their respective trials in this edition of Endovascular Today. We are also fortunate to have the ability to share critical reviews and recommendations regarding the current state of carotid artery stenting.

Sumaira Macdonald, MBChB (Comm.), FRCP, FRCR, PhD; Jonathan Smout, MBChB, MD, FRCS; and Gerry Stansby, BA, MBBChir, MA, FRCS, MChir, address the question if experience matters in relation to carotid stenting, reviewing published series and weighing the relationship among experience and volume and outcome. They conclude that results for CAS are clearly improving as experience increases.

Issam D. Moussa, MD, asserts in his article that the best management of asymptomatic carotid stenosis is based on individual patient selection, with careful analysis of risk stratification. He provides an overview of important considerations when evaluating risk in these patients. E. Bruce McIff, MD, FACR, FSIR, follows with his take on how to lower this learning curve, with a careful examination of procedural steps and device selection. Michael H. Wholey, MD; William Wu, MD; and Boulos Toursarkissian, MD, present a unique method to gain access into the common carotid artery in patients with tortuous and complex anatomy. By using the two techniques they describe, they were able to successfully stent the carotid artery in 44 such patients.

Our carotid stenting update is rounded out with several discussions on recent CAS trials with their investigators, including Thomas G. Brott, MD; Jon S. Matsumura, MD; John Rundback, MD; and Alison Halliday, MS FRCS.

This month, we also have included an update on New Directions in Simulation. Professor Alain Cribier, MD, shares his personal experience with simulation transcatheter heart valve replacement, and David L. Dawson, MD, explores what is next for medical simulation, highlighting the usefulness of this training for endovascular therapies. Our interview is with Ross Milner, MD, who talks with us about recent developments in thoracic, abdominal, and carotid technology, including remote pressure sensing, and gives advice for physicians entering vascular surgery fellowships.

We hope you find this edition of Endovascular Today to be stimulating and informative.