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. 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. Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. UK Medical Research Council and Health Technology Assessment Programme.

A systematic review of endovascular treatment for chronic total occlusion of the internal carotid artery Piotr Myrcha, Peter Gloviczki

Aim The aim of the study was to retrospectively assess the relationship between the occurrence of polyps and colon cancer in patients with type 2 diabetes. Methods In 2014-2015, 976 colonoscopy was performed in patients. We compared the number of polyps with high-grade dysplasia and colorectal cancers in patients with and without diabetes. In addition, in the diabetic group, we documented the relationship between HbA1C and the occurrence of polyps high-grade dysplasia, and colon cancer. The data were statistically analyzed. Result 1) Patients with diabetes have a higher frequency of polyps with high-grade dysplasia/ carcinoma - (32/91 (35.16%) in comparison to patients without diabetes 136/885 (15.37%), p <0.001. 2) Patients with diabetes have a higher frequency of polyps with cancer - (9/91 (9.89%) as compared to patients without diabetes in patients 18/885 (2.03%), p <0.001. 3) Colorectal cancer occurred significantly more often in uncontrolled diabetes (p = 0.022) Conclusion The conducted study shows a significant association between type 2 diabetes and the incidence of colorectal adenomas. These findings may lead to the conclusion that diabetic patients are at a higher risk of developing colorectal cancer thus requiring more need for a controlled colonoscopy. Therefore it may be worth to consider a scheme for screening patients in the group mentioned above by performing colonoscopy.