الفهرس 
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Abstract
Introduction: Asymptomatic carotid artery stenosis (ACAS) is defined as ≥50% narrowing of the carotid artery in the absence of retinal or cerebral ischemia. Asymptomatic carotid stenosis can be managed medically or by revascularization treatment such as carotid endarterectomy (CEA) and carotid artery stenting (CAS). Aim of the work is to: determine clinical, laboratory and neuro radiological predictors for developing cerebral ischemic events in asymptomatic carotid artery stenosis patients and to determine the benefit from early carotid stenting. Subject and methods: This was a cohort prospective study that was conducted on 40 highly risk patients for stroke with (ACAS) of 50% to 99%, through carotid duplex screening of clinically manifest atherosclerotic vessel disease patients. Patients with ACAS > 50% subjected to Clinical, laboratory and radiological assessment at baseline visit to determine highly risk patients for stroke. Patients with ACAS stenosis from 50% to 69 % (group A) subjected to CAS with BMT (group A1) or BMT only (group A2) according to patient acceptance of management plan, financial support and risk of stroke. Patients with ACAS from 70% to 99 % (group B) subjected to CAS according to guidelines. Reevaluating was done after one month then every 6 months for 18 months for all studied groups. Results: Cerebrovascular events (TIA and stroke) were significantly higher in group A2 than group A1 and group B at the end point of follow up period (P value=0.031) as we found three patients developed TIA and three patients developed ischemic stroke in group A2 while, zero patient in group A1 and one patient in group B. In Multivariate regression analysis, smoking index, high SBP, cholesterol, HDL, MRI SBI, echolucent plaque and micro emboli were independent predictors for ischemic stroke in symptomatic patients of group A2. Conclusion: Repair of carotid stenosis by carotid artery stent, in addition to BMT showed good outcome in highly risk asymptomatic carotid artery stenosis patients.