The phenomenon of stentgraft “shortening” during endovascular stentgraft implantation into an abdominal aortic aneurysm in cases involving significant tortuosity of the aorta and iliac arteries.

Introduction: One of the main problems with the implantation of stent-graft (STG) in the abdominal aortic aneurysm (AAA) remains its proper fit. Minor differences in distances from the relevant structures can result in life-threatening complications. This article aims to show the problem of aortic stent-graft shortening during implantation. This occurs in the case of significant tortuosity of the abdominal aorta vessels and iliac arteries. Our study has found a significant correlation between vessel tortuosity and erroneous results of preoperative sizing (using the centerline). The new measurement system developed (along long curves) seems to correlate better with intraoperative images.   Material and methods: The study involved the evaluation of 70 patients sized classically and with the use of the described technique, and then operated on with the EVAR technique. In all patients, stent-grafts were sized classically (using the central lumen line) and along the curvature line of the sized vessels. The dimensions of the stent-graft were selected according to the standard method (classical sizing), and the fit of the STG in relation to the calibrated catheter (“pigtail”), and the final postoperative result was considered to be the final result. There were 44 men (62,8%) and 26 women (37,2 %) in the study group. The mean age of patients was 74 years. Eighty-nine percent of patients were classified as NYHA (Class I-II) and 11 % of patients as NYHA Class III.   Results: Average measurement of the aorta and iliac arteries using the centerline was 201.8 mm, and average measurement based on the curvature of vessels was 222.2 mm. Average measurement using calibrated catheter was 218.1 mm. The results of the analysis showed significant differences between the measurements (centerline and long curvature of vessel): Z = 7.17; p < 0.001; r = 0.87.   Conclusions: The measurement made along the long curves is more accurate than the measurement made with the centerline. The measurement made with the centerline is underestimated (it indicates a smaller value than the actual measurement)

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

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. Findings: 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). Interpretation: 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