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.

After Endurant stent grafting, the incidence of limb occlusion was low. Classifying patients as high risk vs low risk according to the algorithm used in this study may help define specific strategies to prevent limb occlusion and improve the overall results of endovascular aneurysm repair using the latest generation of stent grafts.

ME is a potent predictor of "silent" ischemic brain lesions among patients with carotid stenosis. An analysis of plaque texture can predict the degree of ME during endarterectomy and is more precise than the standard GSM.

Recent studies have shown that time-resolved optical measurements of the head can estimate changes in the absorption coefficient with depth discrimination. Thus, changes in tissue oxygenation, which are specific to intracranial tissues, can be assessed using this advanced technique, and this method allows us to avoid the influence of changes to extracerebral tissue oxygenation on the measured signals. We report the results of time-resolved optical imaging that was carried out during carotid endarterectomy. This surgery remains the "gold standard" treatment for carotid stenosis, and intraoperative brain oxygenation monitoring may improve the safety of this procedure. A time-resolved optical imager was utilized within the operating theater. This instrument allows for the simultaneous acquisition of 32 distributions of the time-of-flight of photons at two wavelengths on both hemispheres. Analysis of the statistical moments of the measured distributions of the time-of-flight of photons was applied for estimating changes in the absorption coefficient as a function of depth. Time courses of changes in oxy- and deoxyhemoglobin of the extra- and intracerebral compartments during cross-clamping of the carotid arteries were obtained. A decrease in the oxyhemoglobin concentration and an increase in the deoxyhemoglobin concentrations were observed in a large area of the head. Large changes were observed in the hemisphere ipsilateral to the site of clamped carotid arteries. Smaller amplitude changes were noted at the contralateral site. We also found that changes in the hemoglobin signals, as estimated from intracerebral tissue, are very sensitive to clamping of the internal carotid artery, whereas its sensitivity to clamping of the external carotid artery is limited. We concluded that intraoperative multichannel measurements allow for imaging of brain tissue hemodynamics. However, when monitoring the brain during carotid surgery, a single-channel measurement may be sufficient.

Aim of the study: Both prevention and treatment of chronic venous disease (CVD) are potentially related to the proper patient knowledge in this field. This paper presents the results of a study commissioned by Polish Society of Phlebology concerning the patient awareness in the field of epidemiology, prevention and treatment of CVD in Poland. Material and methods: The study was performed with the use of computer-assisted interviews conducted on a nationwide representative sample (n = 828) and additionally on a nationwide representative sample of women (n = 177). Results: The most common complaint reported by the respondents was a feeling of heaviness and fatigue in the lower limbs-62%. Thirty-seven percent reported lowerleg pain related to body posture and 33% lower limb swelling. In 27% the presence of varicose veins and in 2% crural ulcers were reported. The majority of symptomatic respondents (64%) never reported their problems to the physicians; 23% of them received assistance from a pharmacist. Among symptomatic patients, compression therapy was used by 11%, 23% took medication, and 18% received dietary supplements. The most common source of information on CVD was the knowledge obtained from friends and families (37%) and from the media (37%). Only 22% indicated the physician as a knowledge resource. As many as 7 out of 10 respondents believed that the education in the area of CVD is necessary. Conclusions: Despite the fact that CVD are widespread among patients, they are still rarely diagnosed by medical personnel and the level of patient knowledge concerning CVD remains low.