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.

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Stroke is one of the leading causes of death and disability worldwide, despite successful strategies to manage the main risk factors for ischemic stroke (hypertension, atrial fibrillation, diabetes mellitus and others). Sleep-disordered breathing (SDB) is poorly studied, but potentially significant and modifiable risk factor for stroke, so it draws attention of investigators. In this review we have focused on some aspects and analyzed the relationship of different variants of SBD with the lesions localization and the type of acute ischemic stroke according to TOAST criteria. During the analysis, it was shown that in the early period after cerebrovascular accident, the frequency and severity of respiratory disturbances in sleep were higher, mainly due to the presence of central apnea, which develops when the vertebro-basilar pool is involved in the blood supply zone. However, impaired cerebral circulation of supratentorial localization can also be a factor contributing to the appearance or exacerbation of respiratory failure in a dream. With regard to the relationship of respiratory disorders in a dream with a type of cerebrovascular accident according to the TOAST classification, we can talk about the likely relationship of obstructive sleep apnea with a cerebrovascular accident of cardioembolic and atherothrombotic origin.

The paper reviews the pathophysiological links between ischemic stroke and sleep-disordered breathing. We discuss well-known mechanisms, such as intermittent hypoxemia, disturbed sleep structure and fluctuations in intrathoracic pressure, autonomic imbalance, oxidative stress, as well as genetic factors and the role of glymphatic system. The impact of sleep-disordered breathing on the development of various subtypes of stroke (according to the TOAST classification) and the so-called “wake-up stroke” is presented.