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of carotid angioplasty and stenting, and progress is now being made in using risk models to determine which individual patients have the most to gain from these interventions. Future challenges include the determination of the role of new technologies, such as the detection of cerebral microemboli (72), in routine clinical practice and the determination of the effect of improvements in medical treatments on the need for surgical and endovascular interventions (73). The only certainty as we look to the future is the continuing need for high-quality clinical research.