The impact of diabetes mellitus on carotid artery stenting: a meta-analysis.

Diabetes is considered to be one of the important factors affecting the prognosis of patients undergoing carotid endarterectomy (CEA), but its effect on carotid stenting (CAS) has not been determined. We performed this analysis to evaluate the impact of diabetes mellitus (DM) on carotid stenting. Studies were searched in the MEDLINE, EMBASE, and Cochrane Library databases for all available studies comparing the outcomes of diabetic and nondiabetic patients who underwent CAS. A meta-analysis was performed using the Mantel-Haenszel model to calculate odds ratios (ORs) with RevMan 5.3 software. Five studies with high quality were ultimately included. A total of 3364 patients underwent CAS, including 1042 diabetic patients and 2322 nondiabetic patients. Meta-analysis showed that there was no statistically significant difference in the risk of perioperative stroke(OR,1.20;95%CI,0.74-1.97;P = 0.46;I2 = 24%), transient ischemic attack(TIA)(OR,1.46;95%CI,0.80-2.66;P=0.22;I2=37%), myocardial infarction(MI)(OR,1.12;95%CI,0.47-2.67;P=0.80;I2=0%), mortality (OR,1.77;95%CI,0.91-3.42;P = 0.09;I2=0%), and composite of stroke or death (OR,1.26;95%CI,0.87-1.81;P = 0.22;I2=35%) between diabetic and nondiabetic patients receiving CAS. Sensitivity analysis showed that the meta-analysis results of all outcome events were stable. Compared with nondiabetic patients, diabetes did not increase the risk of the following: perioperative stroke, TIA, MI, mortality, and composite of stroke or death in patients receiving CAS. This study may be used to guide carotid artery stenosis patients with diabetes to choose the optimal treatment option. However, due to the limited number of studies and the different technical levels of institutions, the results should be interpreted caution.

Metastatic Adenocarcinoma of Unknown Primary in the Bilateral Cerebellopontine Angles: Case Report and Review of the Literature.

Metastatic adenocarcinoma in bilateral cerebellopontine angles (CPA) is rare. We report a case and review the current literature in order to enhance recognition of metastatic adenocarcinoma in the cerebellopontine angle. A 44-year-old man was referred to the hospital with rightsided diminished hearing for 7 weeks, left-sided facial palsy for 2 weeks, and left-sided sensorineural hearing loss for 1 week. On Magnetic Resonance Imaging (MRI) two tumors in bilateral CPAs were detected. The left-sided tumor was resected and histopathological examination revealed an adenocarcinoma. Many investigations could not find the primary tumor. One should be careful with middle-aged or elderly patients with sudden progressive deficits in the VIII < sup > th < /sup > or VII < sup > th < /sup > cranial nerves, particularly in bilateral CPA.