Development and validation of a new tool to estimate early mortality in patients with advanced cancer treated with immunotherapy.

BACKGROUND: Immune checkpoint inhibitors (ICIs) are standard treatments for advanced solid cancers. Resistance to ICIs, both primary and secondary, poses challenges, with early mortality (EM) within 30-90 days indicating a lack of benefit. Prognostic factors for EM, including the lung immune prognostic index (LIPI), remain underexplored. METHODS: We performed a retrospective, observational study including patients affected by advanced solid tumors, treated with ICI as single agent or combined with other agents. Logistic regression models identified factors associated with EM and 90-day progression risks. A nomogram for predicting 90-day mortality was built and validated within an external cohort. RESULTS: In total, 637 patients received ICIs (single agent or in combination with other drugs) for advanced solid tumors. Most patients were male (61.9%), with NSCLC as the prevalent tumor (61.8%). Within the cohort, 21.3% died within 90 days, 8.4% died within 30 days, and 34.5% experienced early progression. Factors independently associated with 90-day mortality included ECOG PS 2 and a high/intermediate LIPI score. For 30-day mortality, lung metastasis and a high/intermediate LIPI score were independent risk factors. Regarding early progression, high/intermediate LIPI score was independently associated. A predictive nomogram for 90-day mortality combining LIPI and ECOG PS achieved an AUC of 0.76 (95% CI 0.71-0.81). The discrimination ability of the nomogram was confirmed in the external validation cohort (n = 255) (AUC 0.72, 95% CI 0.64-0.80). CONCLUSION: LIPI and ECOG PS independently were able to estimate 90-day mortality, with LIPI also demonstrating prognostic validity for 30-day mortality and early progression.

Charge-Transfer Complexes: Halogen-Doped Anthracene as a Case of Study.

Charge transfer (CT) crystals exhibit unique electronic and magnetic properties with interesting applications. We present a rational and easy guide which allows to foresee the effective charge transfer co-crystal production and that is based on the comparison of the frontier molecular orbital (MO) energies of a donor and acceptor couple. For the sake of comparison, theoretical calculations have been carried out by using the cheap and fast PM6 semiempirical Hamiltonian and pure HF/cc-pVTZ level of the theory. The results are then compared with experimental results obtained both by chemical (bromine and iodine were used as the acceptor) and electrochemical doping (exploiting an original experimental set-up by this laboratory: the electrochemical transistor). Infra-red vibrational experimental results and theoretically calculated spectra are compared to assess both the effective donor-acceptor (D/A) charge-transfer and transport mechanism (giant IRAV polaron signature). XPS spectra have been collected (carbon (1 s) and iodine (3d5/2)) signals, yielding further evidence of the effective formation of the CT anthracene:iodine complex.

Intravascular Iliac Artery Lithotripsy to Facilitate Aortic Endograft Delivery: Midterm Results of a Dual-Center Experience.

PURPOSE: To assess the feasibility and safety of intravascular lithotripsy (IVL) for enabling transfemoral abdominal (EVAR), thoracic (TEVAR), and thoracoabdominal (BEVAR) endovascular aneurysm repair in patients with narrow and calcified iliac arteries. MATERIALS AND METHODS: Consecutive patients treated with IVL for severe calcified and narrowed iliac access before EVAR, TEVAR, or BEVAR between November 2020 and June 2022 were retrospectively evaluated. All anatomical iliac characteristics were acquired by multi-planar reconstruction of preoperative computed tomography angiography (CTA). The hostility of the vascular accesses was classified based on Peripheral Arterial Calcium Scoring System (PACSS) and calcified access severity score (CASS), a new score considering both anatomical (calcium grade and length, minimum lumen diameter [MLD], and tortuosity index) and aortic stent-graft (SG/MLD index) parameters. Primary endpoint was technical success defined as successful aortic endograft delivery and deployment without iliac rupture. Freedom from complications and primary patency were additionally analyzed. RESULTS: Twenty-eight iliac axes were treated with IVL (8 bilateral) in 20 patients (mean age 74.5±6.7 years) with a mean follow-up of 26.5±6.2 (range 17-36) months. Ten patients underwent EVAR: 3 TEVAR, and 7 BEVAR procedures. In 14 patients (70%), aneurysm disease was associated with symptomatic aorto-iliac occlusive disease (AIOD), with Rutherford class III to IV. The PACSS was grade IV in 89% of the cases and the CASS (mean 14±2) was grade III to IV in all cases. The stent-graft (SG) outer diameter (5.60±1.65 mm) was significantly larger by 50% than MLD (3.96±1.20 mm), with an SG/MLD index of 1.50±0.51 (p<0.001). Technical success was 100%. No dissection, rupture, or distal embolization occurred. One (3.4%) bail-out stenting was necessary as endoconduit after IVL treatment. One month CTA showed that postoperative luminal gain increased by 93% (p<0.001). An improvement of 2 Rutherford classes occurred in all AIOD patients with a primary patency of 100% at last follow-up. CONCLUSIONS: This study shows the safety and feasibility of IVL as a valuable option to treat narrow and calcified iliac arteries to facilitate endograft delivery. Further studies will be useful to confirm these results. CLINICAL IMPACT: In this article, the use of intravascular iliac artery lithotripsy to facilitate aortic endograft delivery is explored. The presence of iliac severe calcifications still represents a contraindication for aortic endovascular repair. Intravascular lithotripsy increases the feasibility and safety of endovascular aortic procedures, facilitating endograft delivery and reducing the risk of iliac rupture and/or dissections by improving vessel compliance and luminal gain. This novel vessel preparation could be an alternative to "paving and cracking" and/or iliac conduits. This study describes a new score to classify the severity of iliac calcifications, considering anatomical parameters and the profile of aortic endografts delivery system.

Exploring the Impact of Various Wooden Barrels on the Aromatic Profile of Aceto Balsamico Tradizionale di Modena by Means of Principal Component Analysis.

The study examines the unique production process of Aceto Balsamico Tradizionale di Modena PDO (ABTM), emphasizing its complex phases and the impact of raw materials and artisanal skill on its flavor characteristics. Analytical tests focused on the volatile composition of vinegars from different wood barrels at different aging stages, using solid-phase micro-extraction (SPME) coupled with gas chromatography, either with mass spectrometry (GC/MS) or flame ionization detector (FID). Multivariate analysis, including principal component analysis (PCA), was employed to investigate the presence of peculiarities among the volatile profiles of samples of different barrel origin. The research focuses on characterizing the volatile composition of vinegars sourced from individual wood barrels, such as Cherry, Chestnut, Mulberry, Juniper, and Oak. Although it was not possible to identify molecules directly connected to the woody essence, some similarities emerged between vinegar samples from mulberry and cherry barrels and between those of juniper and oak. The former group is characterized by analytes with high molecular weights, such as furfural and esters, while the latter group shows more intense peaks for ethyl benzoate. Moreover, ethyl benzoate appears to predominantly influence samples from chestnut barrels. Due to the highly complex production process of ABTM, where each battery is influenced by several factors, this study's findings are specific to the current experimental conditions.

Hypertransaminasemia in cancer patients receiving immunotherapy and immune-based combinations: the MOUSEION-05 study.

BACKGROUND: The antitumor efficacy of immune checkpoint inhibitors (ICIs) has increasingly emerged during the last few years. However, there is a need to identify the safety profile of these agents more comprehensively, including liver toxicity. MATERIALS AND METHODS: Herein, we performed a meta-analysis to assess the risk of all-grade and grade 3-4 hypertransaminasemia in cancer patients receiving ICIs-as monotherapy or in combination with other anticancer agents. All the relevant trials were retrieved through EMBASE, Cochrane Library, and PubMed/Medline databases; eligible studies were selected according to PRISMA statement. The pooled relative risk (RR) and 95% confidence interval (CI) were extracted. RESULTS: Fifty-nine studies were included. The pooled RRs for all-grade AST and ALT increase were 1.45 (95% CI 1.26-1.67) (Supplementary Fig. 3) and 1.51 (95% CI 1.29-1.77) in patients receiving ICIs monotherapy and immune-based combinations compared to control treatment, respectively. The pooled RRs for grade 3-4 AST and ALT increase were 2.16 (95% CI 1.77-2.64) and 2.3 (95% CI 1.91-2.77). CONCLUSIONS: According to our results, ICIs monotherapy and immune-based combinations were associated with higher risk of all-grade and grade 3-4 hypertransaminasemia. Monitoring liver function should be recommended in cancer patients treated with ICIs monotherapy or immune-based combination, and in case of underlying liver disease, a careful risk-benefit assessment appears as a mandatory need.

Complete remissions following immunotherapy or immuno-oncology combinations in cancer patients: the MOUSEION-03 meta-analysis.

BACKGROUND: Immunotherapy has determined unprecedented long-term responses in several hematological and solid tumors. In the MOUSEION-03 study, we conducted a meta-analysis to determine the possibility of achieving complete remissions (CR) with immunotherapy or immuno-oncology combinations in cancer patients. METHODS: The primary endpoint was to assess the incidence of CR in cancer patients receiving immune checkpoint inhibitors (ICIs) alone or in combination with other agents versus control treatments. The pooled odds ratio (OR) and 95% confidence interval (CI) for CR rate were extracted. RESULTS: A total of 12,130 potentially relevant trials were identified; 5 phase II and 80 phase III randomized studies (37 monotherapies and 48 combinations) and 49,425 cancer patients were included. The most frequent types of malignancies were non-small cell lung cancer (n = 14,249; 29%), urothelial cancer (n = 6536; 13%), renal cell carcinoma (n = 5743; 12%), and melanoma (n = 2904; 6%). In patients treated with immunotherapy (as monotherapy or in combination with other anticancer agents), the pooled OR was 1.67 (1.52-1.84). The highest OR was registered by immune-based combinations with two ICIs (3.56, 95% CI 1.28-9.90). CONCLUSIONS: To the best of the authors' knowledge, no comprehensive meta-analysis on the use of ICIs and ICI-based combinations in solid tumors to systematically investigate the probability to achieve CR has been published so far. Although CR is not a common event in several cancer patients receiving immunotherapy, the MOUSEION-03 suggests that the use of ICIs may significantly increase the chance of achieving CR in comparison with control treatments.

Polyphenolic Compounds in Extracts from Roasted Grapevine Canes: An Investigation for a Circular Approach to Increase Sustainability in the Viticulture Sectors.

In this study, we compared the polyphenolic composition of the roasted grapevine wood chips of four Vitis vinifera cultivars-namely, Sorbara, Grasparossa, Malbo Gentile, and Spergola. These waste byproducts have the potential as infusion chips for the aging of alcoholic beverages and vinegars, contributing to an enriched sensory profile. Roasting amplifies aromatic nuances and triggers the depletion of crucial bioactive compounds, including polyphenols. We investigated the extent of polyphenolic loss in the ethanolic extract of roasted grapevine chips to repurpose this waste byproduct and assess its potential. We assessed the levels of trans-resveratrol, trans-ε-viniferin, trans-piceatannol, and the main resveratrol trimer. Our findings indicated a significant decrease in polyphenol content as the roasting temperature increased, from 16.85-21.12 mg GAE/g for grapevine chips roasted at 120 °C to 3.10-7.77 mg GAE/g for those roasted at 240 °C. This study also highlights notable genotypic differences in polyphenolic content. Among the red grape cultivars analyzed, Sorbara exhibited the highest levels (7.77-21.12 mg/GAEg), whereas the white grape cultivar Spergola showed the lowest polyphenolic content (3.10-16.85 mg/GAEg). These findings not only contribute to the scientific understanding of polyphenol stability but also hold practical implications for the enhancement of aged beverages, as well as advancing sustainable practices in the viticulture industries.

Characterization of Some Stilbenoids Extracted from Two Cultivars of Lambrusco-Vitis vinifera Species: An Opportunity to Valorize Pruning Canes for a More Sustainable Viticulture.

Pruning canes from grape vines are valuable byproducts that contain resveratrol and other health-boosting stilbenoids. This study aimed to assess the effect of roasting temperature on the stilbenoid content of vine canes by comparing two Vitis vinifera cultivars, Lambrusco Ancellotta and Salamino. Samples were collected during different phases of the vine plant cycle. One set was collected in September after the grape harvest and was air-dried and analyzed. A second set was obtained during vine pruning in February and evaluated immediately after collection. The main stilbenoid identified in each sample was resveratrol (~100-2500 mg/kg), with significant levels of viniferin (~100-600 mg/kg) and piceatannol (~0-400 mg/kg). Their contents decreased with increasing roasting temperature and residence time on the plant. This study provides valuable insights into the use of vine canes in a novel and efficient manner, which could potentially benefit different industries. One potential use involves the roasted cane chips to accelerate the aging of vinegars and alcoholic beverages. This method is more efficient and cost-effective than traditional aging, which is slow and unfavorable from an industrial perspective. Furthermore, incorporating vine canes into maturation processes reduces viticulture waste and enhances the final products with health-promoting molecules, such as resveratrol.

Risk of toxicity with immunotherapy-tyrosine kinase inhibitors for metastatic renal cell carcinoma: a meta-analysis of randomized controlled trials.

Aim: Few data are available regarding the safety profile of immunotherapy-tyrosine kinase inhibitor (IO-TKI) combinations in metastatic renal cell carcinoma. The authors investigated all-grade and grade 3-4 (G3-4) adverse events in trials comparing IO-TKI combinations with sunitinib monotherapy. Methods: The relative risks of several all-grade and G3-4 adverse events were analyzed. Results: Relative risks were similar between patients receiving IO-TKI combinations versus sunitinib monotherapy. However, the use of IO-TKI combinations was associated with a higher risk of all-grade and G3-4 diarrhea, all-grade hypothyroidism, G3-4 decreased appetite, all-grade and G3-4 aspartate transaminase increase and all-grade and G3-4 alanine transaminase increase. Conclusion: The results of the authors' meta-analysis suggest that risks of treatment-related adverse events should be carefully considered when choosing IO-TKI combinations in metastatic renal cell carcinoma patients.

VOCs Analysis of Three Different Cultivars of Watermelon (Citrullus lanatus L.) Whole Dietary Fiber.

In this study, the trend of VOCs of dietary fiber samples, coming from three different watermelon cultivars Citrullus lanatus L. (variety Gavina®®, Crimson Sweet, and Asahi Miyako) was investigated. This foodstuff, obtained as a by-product of residual agri-food production, has gained increasing attention because of its many bioactive components and high dietary fiber content. The result is a fibrous material for specific applications in food manufacturing, such as corrector for some functional and technological properties. In this study, a method based on headspace solid-phase microextraction (HS-SPME) coupled with gas chromatography-mass spectrometry (GC-MS) was used to characterize the aromatic profiles of the dried raw materials. Therefore, the VOCs of the samples of the three cultivars were investigated. Experimental results have shown that watermelon fibers generate VOCs, which can be grouped into six common classes of analytes. The different distributions of the identified compounds made it possible to effectively differentiate the three cultivars studied based on their peculiar aroma profiles. In particular, Gavina®® fiber is distinguished by the high content of terpenes, Asahi Miyako by the presence of aldehydes generated as fatty acid metabolites, and Crimson Sweet by the higher content of acetyl esters.

Comparative Analysis of VOCs from Winter Melon Pomace Fibers before and after Bleaching Treatment with H2O2.

In this study, the trend of Volatile Organic Compounds (VOCs) in dietary fiber samples from the winter melon (Cucumis Melo var. Inodorus, Yellow Canary type) were investigated. This foodstuff, obtained as a by-product of agri-food production, has gained increasing attention and is characterized by many bioactive components and a high dietary-fiber content. As regards fiber, it is poorly colored, but it may be whitened by applying a bleaching treatment with H2O2. The result is a fibrous material for specific applications in food manufacturing, for example, as a corrector for some functional and technological properties. This treatment is healthy and safe for consumers and widely applied in industrial food processes. In this study, a method based on headspace solid-phase microextraction (HS-SPME) coupled with gas chromatography-mass spectrometry (GC-MS) was applied for the characterization of the aromatic profile of the dried raw materials. Furthermore, VOC variation was investigated as function of the bleaching treatment with H2O2. The bleached samples were also analyzed after a long storage period (24 months), to assess their stability over time. As a result, the VOC fraction of the fresh raw fiber showed nine classes of analytes; these were restricted to seven for the bleached fiber at t0 time, and further reduced to four classes at the age of 24 months. Alcohols were the main group detected in the fresh raw sample (33.8 % of the total chromatogram area), with 2,3-butanediol isomers as the main compounds. These analytes decreased with time. An opposite trend was observed for the acids (9.7% at t0), which increased with time and became the most important class in the 24-month aged and bleached sample (57.3%).

Successful conversion strategy in patient submitted to EVAR demanding open surgery: comparative analysis 1997-2011 vs 2012-2020.

Late open conversion in our center has been reviewed in the past 8 years, comparing 1997-2011 (first period group A) with 2012-2020 (second period group B). A retrospective analysis of patients treated at our centre by standard EVAR for infrarenal aortic aneurysm requiring late open conversion between January 1997 and February 2020 was performed. All stent grafts were implanted according to their current IFU all patients. The data concerning intra and postoperative complications were collected. Post-operative evaluated data include: ICU (Intensive Care Unit) stay, major peri-operative (<30 days) complications, in hospital mortality, length of hospital stay, 30-days mortality, and mid-term outcomes. Between January 2012 and February 2020 (group B), in our institution 8 patients previously treated by stent graft with endoleak underwent open surgery. The incidence of conversions and the 30-day mortality rate were compared with that of previous years, from January 1997 to December 2011 (group A). 481 patients submitted to EVAR in a second part of the analysis have been considered, 8 patients underwent late open conversion (1.7%) (Group B) due to endoleak. Among January 1997 and December 2011 overall 268 EVAR were performed; during this first study period, surgical conversion had been performed in 14 patients (5.2%) (Group A). The average time from EVAR to open conversion was four years (range 12-88 months) in Group B, and it was 30 months (range 1-82 months) in Group A. In most cases, in both group A and group B the proximal aortic cross-clamping were infrarenal. After the emergent procedure in Group B (12.5%), we have observed a death, whereas three patients died in Group A in urgent situations (21.4%). The more frequent indication for open surgery is the Endoleak type 1 and migration in the two considered periods. Adherence with current IFU and the technical progress in endoprosthesis design maintain lower rate incidence. In most cases, open surgery for prostheses that require explantation can be performed with infrarenal clamping. Partial removal of the endoprosthesis in selected cases makes open conversion easier and appears durable. The results are unfair by numerous comorbidities; in both periods, urgent graft removal seems to elevate both mortality and morbidity, compared to elective surgery.

Quality of life assessment in renal cell carcinoma Phase II and III clinical trials published between 2010 and 2020: a systematic review.

Aims: Quality of life (QoL) assessment is frequently not included among the end points of clinical trials (CTs) on renal cell carcinoma. Herein we aimed to describe the assessment and reporting of QoL in Phase II and Phase III CTs published between 2010 and 2020. Methods: A total of 25 CTs were included; 76% of trials included were conducted in metastatic renal cell carcinoma patients, while 20% of studies evaluated adjuvant systemic treatments. Results: In 13/25 publications, QoL was not listed among the end points, with secondary publications dedicated to QoL present in a minority of cases. Conclusions: QoL was not included among the end points of a large percentage of CTs. Implementing the inclusion of QoL represents an urgent need.

Lay abstract Recent years have seen growing attention toward quality of life (QoL) in medical oncology clinical trials and statistical measurement of this aspect of cancer treatment. Nonetheless, although most clinicians and researchers agree that QoL should represent a fundamental component of clinical trials, the inclusion of QoL results is still inadequate, and our systematic review confirms that implementing the inclusion of QoL remains an urgent need.

The Molecular Characteristics of Non-Clear Cell Renal Cell Carcinoma: What's the Story Morning Glory?

Non-clear cell renal cell carcinomas are a miscellaneous group of tumors that include different histological subtypes, each one characterized by peculiarity in terms of genetic alteration, clinical behavior, prognosis, and treatment response. Because of their low incidence and poor enrollment in clinical trials, alongside their heterogeneity, additional efforts are required to better unveil the pathogenetic mechanisms and, consequently, to improve the treatment algorithm. Nowadays, tyrosine kinase inhibitors, mTOR and MET inhibitors, and even cisplatin-based chemotherapy and immunotherapy are potential weapons that are still under evaluation in this setting. Various biomarkers have been evaluated for detecting progression and monitoring renal cell carcinoma, but more studies are necessary to improve this field. In this review, we provide an overview on the molecular characteristics of this group of tumors and the recently published trials, giving an insight into what might become the future therapeutic standard in this complex world of non-clear cell kidney cancers.

An Insight on Novel Molecular Pathways in Metastatic Prostate Cancer: A Focus on DDR, MSI and AKT.

Prostate cancer is still one of the main causes of cancer-related death in the male population, regardless of the advancements in the treatment scenario. The genetic knowledge on prostate cancer is widely increasing, allowing researchers to identify novel promising molecular targets and treatment approaches. Genomic profiling has evidenced that DNA damage repair genes' alterations are quite frequent in metastatic, castration resistant prostate cancer and specific therapies can interfere with this pathway, showing promising activity in this setting. Microsatellite instability is gaining attention as it seems to represent a predictive factor of the response to immunotherapy. Furthermore, the PTEN-PI3K-AKT pathway is another possible treatment target being investigated. In this review, we explore the current knowledge on these frequent genomic alterations of metastatic prostate cancer, their possible therapeutic repercussions and the promising future treatments under evaluation.

Nanoscale Analysis of Historical Paintings by Means of O-PTIR Spectroscopy: The Identification of the Organic Particles in L'Arlésienne (Portrait of Madame Ginoux) by Van Gogh.

Optical-photothermal infrared (O-PTIR) spectroscopy is a recently developed technique that provides spectra comparable to traditional transmission FTIR spectroscopy with nanometric spatial resolution. Hence, O-PTIR is a promising candidate for the analysis of historical paintings, as well as other cultural heritage objects, but its potential has not yet been evaluated. This work presents the first application of O-PTIR to the analysis of cultural heritage, and in particular to an extremely small fragment from Van Gogh's painting L'Arlésienne (portrait of Madame Ginoux). The striking results obtained, including the detection of geranium lake pigments as well as the complete analysis of the stratigraphy, failed with other state-of-the-art techniques, highlight the potential of this method. The integration of O-PTIR to the study of cultural heritage opens to the possibility of decreasing the amount of sample extracted, therefore contributing to the preservation of the integrity of artworks while providing a complete characterization of the materials.

The Safety of EVAS Surgical Conversion in a Comparative Monocentric Analysis.

BACKGROUND: Endovascular aneurysm sealing (EVAS) was a widespread technology to treat abdominal aortic aneurysm. However, the particular morphology and structure of this endoprosthesis predisposed to proximal sealing defects with a high rate of reintervention or conversion to open surgery treatments. The purpose of this article is to report our experience on late open conversion of Nellix device, compared with the previous reported experience. MATERIALS AND METHODS: Between September 2013 and February 2020, eight late open surgical conversions for endoleak (EL) were performed in our center: four of these were for EVAR. Four of these were EVAS devices required explantation and were included in the study. All excisions of infected abdominal aortic endograft were excluded. RESULTS: All patients were treated within the original instructions for use. Aorto-bi-iliac reconstruction was performed with a bifurcated Dacron graft in all the four cases. At 12 months Doppler ultrasonography follow-up, good results at short term with preserved primary patency and freedom of re-intervention in three cases were reported. Only one patient died 16 days after the procedure. Nevertheless, the endoprosthetic structure allows in three of our cases to clamp down the renal level, with a decrease of the time of lower limbs ischemia and greater safety of the open surgery repair procedure. CONCLUSIONS: The EVAS conversion is common, and a closer follow-up is required. The most recurrent open surgery indication is its migration and the EL type 1. The procedure is influenced by multiple comorbidities; emergency graft excision appears to increase morbidity and mortality, compared with elective surgical setting.

Use of Lead Isotopic Ratios as Geographical Tracer for Lambrusco PDO Wines.

In this study, the lead isotope signature was tested with the aim to verify its potential as geographic tracer for wine production and particularly for the Lambrusco PDO wines of the province of Modena (Italy). A solid phase extraction procedure, for separating lead from the investigated matrices, soil and wine, was optimized. Furthermore, different mathematical models, based on an exponential law and internal or external correction approach, were evaluated for the correction of instrumental mass dependent fractionation. The optimized analytical procedure yielded isotopic ratio data relative to the lead NIST 981 standard, 208Pb/206Pb = 2.16664 and 207Pb/206Pb = 0.914645, in good agreement both with the tabulated values and with the most recent literature data. Measured isotope ratio data highlight the contribute of multiple lead sources in bottled wine but different from the one present in soils.

Carotid Artery Stent Placement and Carotid Endarterectomy: A Challenge for Urgent Treatment after Stroke-Early and 12-Month Outcomes in a Comprehensive Stroke Center.

PURPOSE: To compare feasibility, 12-month outcome, and periprocedural and postprocedural risks between carotid artery stent (CAS) placement and carotid endarterectomy (CEA) performed within 1 week after transient ischemic attack (TIA) or mild to severe stroke onset in a single comprehensive stroke center. MATERIALS AND METHODS: Retrospective analysis of prospective data collected from 1,148 patients with ischemic stroke admitted to a single stroke unit between January 2013 and July 2015 was conducted. Among 130 consecutive patients with symptomatic carotid stenosis, 110 (10 with TIA, 100 with stroke) with a National Institutes of Health Stroke Scale (NIHSS) score < 20 and a prestroke modified Rankin Scale (mRS) score < 2 were eligible for CAS placement or CEA and treated according to the preference of the patient or a surrogate. Periprocedural (< 48 h) and postprocedural complications, functional outcome, stroke, and death rate up to 12 months were analyzed. RESULTS: Sixty-two patients were treated with CAS placement and 48 were treated with CEA. Several patients presented with moderate or major stroke (45.8% CEA, 64.5% CAS). NIHSS scores indicated slightly greater severity at onset in patients treated with a CAS vs CEA (6.6 ± 5.7 vs 4.2 ± 3.4; P = .08). Complication rates were similar between groups. mRS scores showed a significant improvement over time and a significant interaction with age in both groups. Similar incidences of death or stroke were shown on survival analysis. A subanalysis in patients with NIHSS scores ≥ 4 showed no differences in complication rate and outcome. CONCLUSIONS: CAS placement and CEA seem to offer early safe and feasible secondary stroke prevention treatments in experienced centers, even after major atherosclerotic stroke.