[2008] 8 Safety and efficacy of carotid stenting What is the safety and efficacy of carotid stenting compared with carotid endarterectomy when these procedures are carried out within 2 weeks of TIA or recovered stroke? Why this is important Carotid stenting is less invasive than carotid endarterectomy and might be safer, particularly for patients very soon after a TIA or stroke, for whom the risks of general anaesthetic might be high. However, neither the risk of stroke nor long-term outcomes after early carotid stenting are known. A randomised controlled trial comparing these interventions early after stroke would determine which of them is associated with the best outcome, as well as comparing their relative safety and cost effectiveness. [2008] 2022 Rationale and impact These sections briefly explain why the committee made the recommendations and how they might affect practice. Initial management of suspected and confirmed transient ischaemic attack (aspirin) Why the committee made the recommendation There was some evidence for a benefit of aspirin in the early management of confirmed transient ischaemic attack (TIA) or minor stroke in reducing the risk of stroke or recurrent stroke in secondary care in stroke services units. This is not directly applicable to the area of review, which was about TIA at first contact with a healthcare professional. However, in the committee's experience, the earlier that aspirin can be administered, the better this will also be for patient outcomes in this group. The risk of haemorrhage in this group, and of other risks associated with administering aspirin (aspirin allergy or gastrointestinal bleed), is low. The recommendation was based largely on the knowledge and experience of the committee supported by the indirect evidence. How the recommendation might affect practice The recommendation represents a change from current practice. 