Background Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence.Methods ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362.

No abstract

Injuries to the branches of the aortic arch are rare and may be caused by blunt, penetrating, blast or iatrogenic trauma. Innominate vascular injury is a rare entity, particularly in blunt trauma. It is estimated that 71% of patients with innominate injuries die before arrival at the hospital. We report here a successfully managed case of a combined blunt trauma of the innominate artery and transection of the left innominate vein after blunt injury to the chest.

Background Various techniques have been used for the execution of carotid endarterectomy; primary (PC), patch closure (CP) and eversion technique (ET).The superiority of any of them is still unproven. The aim of this study was to compare the long-term outcomes of each technique in terms of cerebrovascular event (CVE), restenosis, survival and major cardiac event (MACE). Methods Between 2007 and 2018, a retrospective analysis of prospectively recorded data from three European tertiary centers was undertaken including 1.357 patients. Demographics, comorbidities and medical treatment were analyzed in relation to long-term outcomes. Freedom from CVE, restenosis ([ 70%), survival and MACE were estimated with Kaplan-Meier analysis curve. Results The mean age was 69.5 ± 8 (72% males;79% asymptomatic). 472 (35%) were treated with PC, 504 (37%) with CP and 381 (28%) with ET. Differences among groups were observed in age (P \ 0.001), gender (P \ 0.01), hypertension (P = 0.01), dyslipidemia (P \ 0.001) and statin treatment (P \ 0.001). The mean follow-up was 4.7 ± 3 years (median: 5 years). Seventy-three patients presented a CVE during 8 years of follow-up. The freedom from CVE including all techniques was 96% (SE 0.6%), 93% (SE 1%) and 89% (SE 1.6%), at 2, 5 and 8 years of follow-up, respectively, with no difference between groups (P .289). Freedom from restenosis was at 96% (SE 0.7%) and 89% (SE 5%) at 5 and 10 years, respectively, for all methods without differences. ET was associated with a higher mortality rate (P \ 0.001) and MACE rate (P \ 0.001). Conclusions Excellent outcomes were achieved with all types of closure techniques with low rates of MACE and other adverse events during long-term follow-up after CEA.

No abstract