Since being presented the results of the two major multicenter trials ECST (European Carotid Surgery Trial) and NASCET (North American Symptomatic Carotid Surgery Trial), it is very decisive to precisely evaluate the degree of symptomatic carotid artery stenosis prior to the procedure with regard to the specific therapeutic management decision: carotid endarterectomy in angiographically verified stenosis >70 % or standard medical treatment with antiplatelet agents, primarily aspirin, in mild or moderate stenosis (10, 20). Due to different angiographic measurement formula, the results of both studies are not directly comparable with each other: while in the ECST trial the residual lumina were compared with the estimated original lumina at the site of the stenosis ("local degree of stenosis"), the so-called distal degree of stenosis was calculated by charging the ratio between the residual lumina and the diameter of the intact distal internal carotid artery. These different measurements are the reason, that the local degree of a 82 % stenosis (ECST criteria) corresponds with the distal degree of a 70 % stenosis (NASCET criteria); to a local degree of a 50 % stenosis no distal degree of stenosis can be calculated (0 %).

Objective: To compare the degree of vessel narrowing seen on selective and non-selective carotid artery catheter angiograms using criteria set by NASCET and ECST with the results obtained from corresponding surgical specimens. Subjects: In 40 preoperative angiograms (20 non-selective, 20 selective) the 'distal' degree of internal carotid artery (ICA) stenosis according to NASCET criteria and the 'local' degree of stenosis according to ECST criteria was assessed. These data were compared with the 'distal' and 'local' degree of ICA stenosis obtained by measuring the specimens and the diameter of the distal ICA intraoperatively. Results: The median 'local' degree of stenosis was 86.5% in the specimen and 83.5% in the selective angiograms (difference not significant). In non-selective angiography the median 'local' degree of stenosis was 77.5% compared to 84% in the corresponding specimens (P < 0.01). The median 'distal' degree of stenosis in selective angiography was 76.5 versus 75.5% in the specimens (n.s.). The median 'distal' degree of non-selective angiography was 67% compared to 77.5% in the corresponding specimens (P = 0.02), The trend to underestimate high grade stenosis (above 90%) was more pronounced in non-selective than in selective angiography. Medium grade stenosis (60-80%) was slightly overestimated in selective angiography. Conclusion: Selective angiography is more accurate in determining the 'true' degree of stenosis in internal carotid artery disease, taking into account a slight overestimation of medium grade stenosis, High grade stenosis is underestimated in both selective and non-selective angiography, These observations extend to both the ECST and NASCET criteria of measuring the degree of stenosis, which differ by about 10%. (C) 1997 Elsevier Science Ireland Ltd.

PURPOSE To compare the degree of carotid artery stenosis in angiography and CT angiography with the degree of stenosis measured in an intact eversion endarterectomy specimen. METHODS Preoperative angiograms (intraarterial DSA, 512 x 512 matrix) and CT-angiograms (24 sec spiral scan, slice thickness 2 mm, pitch 1.5) were taken in 12 patients with symptomatic carotid stenosis. Evaluation of the degree of stenosis was performed according to the NASCET ("distal" degree) and ECST ("local" degree) methods. These data were compared with measurements of the surgical specimens. RESULTS The median "local" degree of stenosis in angiograms was 81.5% (range: 70-99%), in CT angiograms 83% (59-94%) and in specimens 85.5% (65-96%). The "distal" degree of stenosis was 79% (50-99%) in angiograms, 85.5% (55-99%) in CT angiograms and 81% (52-95%) in specimens. CT angiography slightly overestimated the degree of stenosis compared with the specimen, whereas angiography slightly underestimated the true degree of stenosis. However, these differences were not statistically significant. CONCLUSION CT angiography is able to predict the degree of internal carotid stenosis when compared with an intact surgical specimen. It is as accurate as the "gold standard" of invasive angiography.

CT angiography is able to predict the degree of internal carotid stenosis when compared with an intact surgical specimen. It is as accurate as the "gold standard" of invasive angiography.

Purpose: To compare the degree of carotid artery stenosis in angiography and CT angiography with the degree of stenosis measured in an intact eversion endarterectomy specimen.Methods: Preoperative angiograms (intraarterial DSA, 512 x 512 matrix) and CT-angiograms (24 sec spiral scan, slice thickness 2 mm, pitch 1.5) were taken in 12 patients with symptomatic carotid stenosis. Evaluation of the degree of stenosis was performed according to the NASCET (''distal'' degree) and ECST (''local'' degree) methods. These data were compared with measurements of the surgical specimens.Results. The median ''local'' degree of stenosis in angiograms was 81.5% (range: 70-99%), in CT angiograms 83% (59-94%) and in specimens 85.5% (65-96%). The ''distal'' degree of stenosis was 79% (50-99%) in angiograms, 85.5% (55-99%) in CT angiograms and 81% (52-95%) in specimens. CT angiography slightly overestimated the degree of stenosis compared with the specimen, whereas angiography slightly underestimated the true degree of stenosis. However, these differences were not statistically significant.Conclusion: CT angiography is able to predict the degree of internal carotid stenosis when compared with an intact surgical specimen. It is as accurate as the ''gold standard'' of invasive angiography.

UNLABELLED:22 carotid specimens following eversion-endarterectomy were compared with preoperative assessment of carotid stenosis obtained angiographically and by c-w-Doppler-sonography. The intact, unsplit specimens were perfused with a liquid plastic material (Palavit M). After hardening of the plastic material the specimens were removed. The local degree of carotid stenosis with respect to diameter reduction was assessed by direct measurement of the plastic specimens at the narrowest site compared with the diameter of the carotid eversion specimens at the place of the maximum stenosis. The distal degree of carotid stenosis was assessed by comparison of the diameter of the distal internal carotid artery obtained intraoperatively with the measurements of the plastic specimens (1 mm vascular wall thickness of distal internal carotid artery was taken into account).RESULTS:Both the local and the distal degree of carotid stenosis diameter (mean 84.7% +/- 8.4% and 82.1% +/- 9.1% respectively) were underestimated in the preoperative angiogram (79.8 +/- 9% by ECST-criteria and 69 +/- 10.3% by NASCET-criteria) in most of the cases. The difference of the diameter reduction was statistically significant (p < 0.05 and p < 0.01 respectively, Wilcoxon signed rank test). The c-w-Doppler assessments were 82.6 +/- 8.2% (n.s.).CONCLUSION:Our results suggest that the preoperative assessment of internal carotid stenosis obtained angiographically or by c-w-Doppler-sonography easily underestimate the true degree of carotid stenosis.

22 carotid specimens following eversion-endarterectomy were compared with preoperative assessment of carotid stenosis obtained angiographically and by c-w-Doppler-sonography. The intact, unsplit specimens were: perfused with a liquid plastic material (Palavit M(R)). After hardening of the plastic material the specimens were removed. The local degree of carotid stenosis with respect to diameter reduction was assessed by direct measurement of the plastic specimens at the narrowest site compared with the diameter of the carotid eversion specimens at the place of the maximum stenosis. The distal degree of carotid stenosis was; assessed by comparison of the diameter of the distal internal carotid artery obtained intraoperatively with the measurements of the plastic specimens (1 mm vascular wall thickness of distal internal carotid artery was taken into account). Results: Both the local and the distal degree of carotid stenosis diameter (mean 84,7% +/- 8,4% and 82,1% +/- 9,1% respectively) were underestimated in the preoperative angiogram (79,8 +/- 9% by ECST-criteria and 69 +/- 10,3% by NASCET-criteria) ill most of the cases. The difference of the diameter reduction was statistically significant (p < 0.05 and p < 0.01 respectively, Wilcoxon signed rank test). The c-w-Doppler assessments were 82,6 +/- 8,2% (n. s.). Conclusion: Our results suggest that the preoperative assessment of internal carotid stenosis obtained angiographically or by c-w-Doppler-sonography easily underestimate the true degree of carotid stenosis.

PURPOSE:The study was carried out to evaluate clinical and technical success, early and late complications and patency rates after stent angioplasty of atherosclerotic stenoses and occlusions of the infrarenal abdominal aorta and aortic bifurcation.PATIENTS AND METHODS:This was a prospective study in 20 consecutive patients treated by implantation of balloon-expandable stents. All patients were followed-up after 6 and 12 months and at yearly intervals thereafter by physical examination, Doppler sonography and angiography.RESULTS:Nineteen of 20 patients had clinical and technical success. In two patients clinically relevant complications occurred. During a mean observation time of 19 months (range 3-51 months) restenosis occurred in one stent after 15 months and was successfully treated by balloon angioplasty. Two patients became symptomatic again due to new atherosclerotic disease.CONCLUSIONS:Percutaneous stent angioplasty of the infrarenal aorta and aortic bifurcation yields high immediate and mid-term success rates with primary patency of 90% and secondary patency of 95%. These results are slightly better than those with balloon angioplasty, but the limited number of patients in our and others' studies does not yet justify general recommendations.

The clinical course of 23 patients with 28 renal artery aneurysms (RAAs) is reported. The RAAs were recorded over a period of 10 years. Thirty-five per cent of the RAAs (eight of 23 patients) were detected during the investigation of hypertension, whereas 26% (six of 23 patients) were discovered incidentally while imaging atherosclerotic arterial disease in the aorto-iliac region by angiography. Twenty-two aneurysms were treated surgically and primary nephrectomy was necessary in one case. The surgical technique used was excision of the aneurysm with bypass grafting in 13 cases (seven Dacron, five vein, one arterial bypass), a running suture following aneurysm excision in four cases and an end-to-end anastomosis in two cases. The results (for a period of 1-10 years) were excellent in all but three cases: two early graft occlusions (vein interposition) and one late occlusion (Dacron bypass) in the course of a re-operation which had become necessary because of a ruptured aneurysm of the gastro-epiploic artery after 3 months. Three of 23 patients were treated by embolisation of four intraparenchymal aneurysms. The follow-up of a non-treated saccular aneurysm showed a total thrombosis of the aneurysm within 4 years and fixed renal hypertension developed later in this patient. We suggest surgical repair of an RAA regardless of its size and the clinical symptoms, in order to prevent microembolism into the renal parenchyma and to avoid the development of fixed renal hypertension. Intrarenal aneurysms can be treated by embolisation to stop severe haematuria thus preserving the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

Between 1980 and 1990, 21 patients with 26 renal artery aneurysms (0.4-16.5 cm in diameter) were diagnosed and treated at the Surgical Center, University of Heidelberg. Surgical reconstructive methods were applied to treat extrarenal and interventional embolization to treat intrarenal aneurysms. The most effective diagnostic method is selective intraarterial angiography. The etiology, age distribution, localization and clinical aspects are discussed. Four bleeding intrarenal aneurysms were embolized with full preservation of renal function (one solitary kidney). After surgical reconstruction of the aneurysmatic vessel, 80% of the hypertensive patients turned normotensive. Follow-up of a nontreated sacciform aneurysm showed total thrombosis within 4 years. In the same period, fixed renal hypertension developed in the patient because of recurrent microembolism in the renal parenchyma. Therefore, we suggest immediate treatment of a renal aneurysm to prevent the development of renal hypertension.

Four cases of intra- and extrahepatic aneurysms of the hepatic artery are discussed concerning the etiology, symptoms, therapy and complication rate. The diagnostic approach and problems in differential diagnosis are specified. Localization of the aneurysm and especially the relationship of the collateral circulation of the hepatic bed are essential to plan the therapy and are based on angiography. Interventional therapeutic techniques are favored for intrahepatic localization. Reconstructive or ablative surgery is indicated to treat the extrahepatic aneurysm.