Background and Purpose-We aimed to identify and determine the clinical relevance of parameters predictive of stroke recurrence and vessel occlusion before carotid endarterectomy. Methods-One hundred forty-three consecutive patients (105 men; mean age, 66.1Ϯ8 years) with symptomatic severe carotid artery stenosis were prospectively followed up until carotid endarterectomy. Patients had suffered an ischemic vascular event in the ipsilateral anterior circulation 9.6 days (median; range, 0 to 92 days) before presentation and assessment of stenosis. Admission examination included medical history, neurological status, extracranial and transcranial Doppler/duplex sonography, CT/MRI, ECG, and routine laboratory examination. All patients were reevaluated in the same way the day before surgery (without CT/MRI) and at recurrence of an ischemic event (including CT/MRI). Results-The end point of follow-up after 19.0 days (median; range, 0 to 118) was carotid endarterectomy in 120 patients, ipsilateral recurrent ischemia in 15 patients (7 transient events and 8 disabling strokes, with carotid occlusion in 4), and (asymptomatic) carotid occlusion in 8 patients. An exhausted cerebrovascular reactivity as determined by a Doppler CO 2 test in the middle cerebral artery ipsilateral to the stenosis was the only independent predictive parameter for disabling stroke (odds ratio [OR], 9.7; 95% confidence interval [CI], 2.1 to 44.1; Pϭ0.003). Stroke rate in patients with exhausted reactivity was 27% per month compared with 5.2% in those with normal reactivity. Progression of stenosis toward occlusion was observed in 12 patients and correlated with decreased poststenotic peak systolic velocity (OR, 0.75; 95% CI, 0.62 to 0.90; Pϭ0.002), poststenotic arterial narrowing (OR, 22.7; 95% CI, 3.6 to 141.6; Pϭ0.001), and very severe stenosis (OR, 13.6; 95% CI, 2.2 to 83.7; Pϭ0.005). In patients without hemodynamic compromise, occlusion was not associated with increased stroke risk. Conclusions-Patients with recently symptomatic high-grade carotid artery stenosis and ipsilateral hemodynamic compromise are at high risk for early disabling stroke. Assessment of the hemodynamic status is recommended after diagnosis of severe carotid stenosis in symptomatic patients to further investigate and evaluate whether these patients may benefit from early endarterectomy.

The results may indicate that silver-coated vascular polyester grafts activate neutrophils chronically which may favor tissue destruction and impaired antimicrobial effects.

Zusammenfassung. Grundlagen: Die Embolisation von Viszeralarterienaneurysmata wird zunehmend als sinnvolle und nützliche Alternative zur Operation gewertet.Methodik: Im vorgestellten Fall wurde das sakkuläre Aneurysma der Milzarterie an ihrer ersten Bifurkation therapeutisch mit einer supraselektiven Katheterembolisation mit Mikrospiralen ausgeschaltet.Ergebnisse: Nach einem Intervall von 4 Wochen wurde angiographisch noch eine Restperfusion (0,3 mal 0,6 mm groß) im Halsbereich des vorherigen Aneurysmas nachgewiesen. Eine erneute supraselektive Katheterembolisation mit Mikrospiralen wurde jedoch wegen angiographisch nachgewiesener Gefäßspasmen in der A. lienalis nicht durchgeführt. Weitere 8 Wochen später zeigte eine Kontrollangiographie eine Thrombose des vorher diagnostizierten Aneurysmas, bestätigte nur noch geringe Kontrastmittelanfärbung des ehemaligen Aneurysmahalses und zeigte keinerlei Anhaltspunkt für rheologische Abnormitäten der arteriellen Milzdurchblutung.Schlussfolgerungen: Die supraselektive Katheterembolisation mit Mikrospiralen als "First-line"-Therapie ist geeignet, um ein sakkuläres Milzarterienaneurysma zu behandeln.Schlüsselwörter: A. lienalis, Aneurysma, Embolisation, Spirale.Summary. Background: Embolization of visceral artery aneurysms has been increasingly accepted as a beneficial alternative to surgery.Methods: The aim of this case report was to evaluate the feasibility of the endovascular therapy of a saccular aneurysm of the splenic artery at its first bifurcation. We approached the aneurysm with a supraselective catheter embolization using coils.Results: After an interval of 4 weeks, we found a residual perfusion (0.3 by 0.6 mm) within the former neck in the control angiography. A repeat supraselective embolization was not favored because of catheter-induced vascular spasms of the splenic artery. A further 8 weeks later, control angiography revealed thrombosis of the previously diagnosed aneurysmatic sac, confirmed only minor residual flow through the thrombosed neck of the former aneurysm, and indicated sustained spleen blood supply as further revealed in later duplex ultrasonography follow-up.Conclusions: Selective coil embolization as first-line therapy to treat saccular splenic artery aneurysm is feasible.

In daily practice, an atypical renal blood supply is a rare finding. An ectopic origin of the right main renal artery from the contralateral common iliac artery was observed when angiography was performed to diagnose irregularities in perfusion of the lower extremities and to determine the necessity for vascular surgical intervention in a 66-year-old man. Conservative treatment was successful in this patient, who suffered from intermittent claudication because of an obstruction of the superficial femoral arteries. The diagnostic approach with angiography is considered to be essential for revealing such anomalies. Conventional vascular surgical reconstruction would have threatened the perfusion of the right kidney in this case.

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