Transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) is one of the most frequently applied standard treatments for this disease. The role for TACE is fairly well defined within the most widely used treatment algorithm for HCC, die Barcelona Clinic Liver Cancer (BCLC) staging system and treatment algorithm. But no general treatment algorithm will go into the technical details of any procedure and several patients will not fit ideally into the patient groups predefined in BCLC or any other treatment algorithm. Furthermore, indications and contraindications sometimes are viewed differently by the various medical specialties involved in taking care of such patients. We present here the joint expert position statement of the Austrian Societies of Gastroenterology and Hepatology (ÖGGH), Interventional Radiology (ÖGIR), Hematology and Oncology (ÖGHO), and Surgical Oncology (ASSO) on the technical aspects, indications, and contraindication for the use of TACE in the management of HCC.

Purpose: To evaluate the role of 4 different reformation techniques and axial images from multidetector computed tomographic angiography (MDCTA) versus selective carotid arteriography (SCA) in patients with internal carotid artery (ICA) stenosis.Methods: Imaging studies from 50 patients (43 men; mean age 70.3 +/- 8.0 years, range 5185) with known cerebrovascular disease who underwent MDCTA and SCA in a single university hospital were retrospectively analyzed. Axial images, multiplanar reformation (MPR), curved planar reformation (CPR), volume rendering threshold (VRT), and virtual angioscopy (VA) images were reviewed by 2 independent observers who were blinded to the results of SCA, which served as the gold standard. The degree of stenosis was categorized as 0%-49%, 50%-69%, or 70%-99%; a stenosis >70% was considered as hemodynamically significant.Results: Thirty-four hemodynamically significant stenoses were identified on SCA. The agreement with SCA images was good for both observers using axial CT images (kappa=0.89 for observer 1 and 0.88 for observer 2); corresponding results for MPR and CPR were kappa=0.91 and 0.92 for observer 1 and 0.88 and 0.91 for observer 2, respectively. VRT (kappa=0.72 for observer 1 and 0.66 for observer 2) and VA (kappa=0.74 for observer 1 and 0.70 for observer 2) showed a slightly inferior correlation with SCA images. Sensitivities for reformations and axial CT images were 100% each; corresponding specificities ranged from 85% to 95%.Conclusion: Axial images as well as all 4 reformation techniques agreed well with SCA in the grading of ICA stenosis. J Endovasc Ther. 2009;16:336-342

Introduction: Idiopathic subclavian vein thrombosis (SVT) is a rare disease but these otherwise healthy patients often suffer from prolonged clinical manifestations. The aim of this retrospective study was to assess the range and severity of thrombosis-related disability of the upper extremity in patients after an episode of documented idiopathic SVT in the long-term follow-up.Materials and Methods: The quality of life (QoL) of 37 patients with documented idiopathic SVT was assessed by two standardized questionnaires (DASH and SF 36). The DASH and SF-36 questionnaire each use a 100 point scale. 0 stands for uncompromised functioning, 100 for maximum limitation in the DASH, while in the SF-36 0 marks the lowest rating of QoL and 100 indicates the best imaginable quality of life.Results: Mean follow-up time was 120 +/- 80.1 months (range: 14 to 286 months). The mean DASH score was 10.7 +/- 12 and the mean scores for the SF-36 dimensions Physical Component Summary (PCS) and Mental Component System (MCS) were 52 +/- 9.3 and 46.3 +/- 9.5, respectively.Conclusions: Patients suffering from idiopathic SVT report good overall QoL judged by the mean DASH and satisfactory QoL by the SF-36 score in the long-term follow-up. These patients deal well with their physical limitations. (C) 2009 Elsevier Ltd. All rights reserved.

INTRODUCTION:The aim of this study was to evaluate the feasibility and accuracy of commercially available software directly implemented on the ultrasound scanner for automated measurement of the intima-media thickness (IMT) of the common carotid artery on source images.MATERIALS AND METHODS:Measurements were performed on a GE Vivid 3 ultrasound scanner. First, inter- and intraobserver correlations were assessed for the automated and the manual measurements. Second, the correlation between automated and manual measurements was assessed in 199 asymptomatic patients with a mean age of 30 years (range 20-41 years).RESULTS:The measurement was feasible in all patients and a standard configuration with optimum quality was determined. The inter- and intraobserver correlations obtained using the automated software were excellent and slightly inferior to the manual measurements. The correlation of the automated and manual measurements was significant (r = 0.86; P < 0.01) and the mean difference between both measurements was low (0.023 +/- 0.034 mm).CONCLUSIONS:The software allowed an efficient and quick measurement by providing at the same time comparable results to the manual measurement and a better inter- and intraobserver variability.

Purpose: Carotid plaque echolucency seen at ultrasonography (US) is a potential indicator of plaque instability and may help identify patients at risk for major adverse cardiovascular events (MACEs). The authors performed this study to determine whether decreasing gray-scale median (GSM) levels at repeat carotid US examinations are associated with future MACEs.Materials and Methods: The study was approved by the institutional ethics committee and all patients provided informed consent. The authors prospectively studied 574 patients with carotid plaques of at least 30% from a group of 1268 consecutive patients who were initially asymptomatic with respect to carotid disease. GSM levels were determined with carotid US at baseline and after a median of 7.5 months (range, 6-9 months), and the mean change of the GSM was calculated. Patients were then followed up clinically for a median of 3.2 years for the occurrence of composite MACE.Results: During the initial period, the median change in carotid GSM was 2.9 (interquartile range [IQR], -6.9 to 11.0). Of 574 study participants, 230 (40%) showed a reduction of GSM levels and 344 (60%) showed an increase. MACEs were observed in 177 (31%) of the 574 patients. Adjusted hazard ratios for the lowest quartile (GSM change less than -6.9), the second quartile (GSM change between -6.9 and 2.9), and the third quartile (GSM change between 3.0 and 11.0) were 1.71 (95% confidence interval [CI]: 1.09, 2.66), 1.36 (95% CI: 0.86, 2.16), and 1.22 (95% CI: 0.77, 1.95), respectively, compared with the highest quartile (GSM change greater than 11.0) (P = .018).Conclusion: Increasing echolucency of carotid artery plaques within a 6-to 9-month interval is predictive of midterm clinical adverse events of atherosclerosis. (C) RSNA, 2008.

BACKGROUND AND PURPOSE:The noninvasive identification of plaque types prone to cause symptomatic disease is of great interest to improve the effectiveness of surgical or interventional management. The purpose of the present prospective pilot study was to evaluate the association between the results of imaging-the novel sonography technique B-flow imaging (BFI), B-mode, and color Doppler imaging (CDI)-and histopathologic examination in the characterization of internal carotid artery (ICA) plaques.METHODS:Twenty-eight consecutive patients with high-grade internal carotid artery stenosis scheduled for carotid endarterectomy were included. BFI, B-mode, and CDI images were used to classify the plaques applying the standardized scores of Beletsky et al and the American Heart Association (AHA), to calculate the gray-scale median (GSM) and to detect potential ulcerations; histopathologic examination results of explanted plaques served as the "gold standard."RESULTS:Based on the classification of Beletsky et al, BFI and histopathologic examination results agreed in 21 (75%, kappa = 0.61, P < .001) patients, and the corresponding results for B-mode were 19 (68%, kappa = 0.52, P < .001) patients, respectively. Corresponding results for the AHA classification revealed inferior agreements for BFI (19 patients/68%, kappa = 0.38, P = .003) and B-mode (17 patients/61%, kappa = 0.25, P = .045). The median GSM for BFI and B-mode correlated significantly (r = 0.95, P < .001). The sensitivity of BFI for the detection of ulcerated plaques was 100% and the specificity was 95.8%; corresponding values for CDI were 100% and 92.7%, respectively.CONCLUSION:BFI and the combination of B-mode and CDI exhibit comparable results in the assessment of ICA plaque components and plaque ulceration as well as in the determination of GSM levels.

We have read with interest the comments of Drs Froio and Biasi, who discussed their findings of a significant relation between plaque echolucency and the risk of stroke in carotid artery stenting (CAS).1 They concluded that the discrepancy between their findings and our results, indicating no significant effect of …

BACKGROUND AND PURPOSE:In contrast to digital subtraction angiography (DSAdia), computed tomography angiography (CTA) provides exact delineation of the perfused lumen in the axial plane, thus allowing luminal (CTAdia) as well as cross-sectional area (CTAarea) internal carotid artery stenosis (ICAS) assessment. The purposes of the present study were to correlate CTAdia and CTAarea with DSAdia and to assess the inter-observer variabilities of both CTA techniques. METHODS:In a retrospective analysis, CTA images were reviewed by two observers and ICAS was assessed according to North American Symptomatic Carotid Endarterectomy Trial applying CTAdia and CTAarea. DSAdia was assessed by a third observer. RESULTS:Based on 54 consecutive patients (40 males [74.1%] and 14 females [25.9%]; median age 73.3 years), ICAS percentages of CTAdia and CTAarea revealed significant correlations with DSAdia (r= 0.79-0.87, all P<.001) with median differences in the range of +8% to -6%. Inter-observer agreement was moderate for CTAdia (kappa= 0.60) and excellent for CTAarea (kappa= 0.86). Sensitivity of CTAarea for the detection of ICAS >70% was 100% for both observers, corresponding results for CTAdia were 97.1% and 71.4%, respectively, using DSAdia as the gold standard. CONCLUSION:CTAarea assessment of ICAS correlates well with the results of DSAdia and provides an excellent sensitivity for the detection of ICAS >70% with superior inter-observer agreement compared to CTAdia.

The objective of the present study was to evaluate the role of skin tissue cholesterol (SkinTc) in predicting the presence of atherosclerosis. SkinTc concentrations were determined in 318 consecutive patients by using the non-invasive PREVU POC Skin Sterol Test. Additionally, a complete lipid status and cardiovascular risk profile according to the PROCAM and Framingham scores as well as an evaluation by carotid duplex sonography and ankle—brachial blood pressure index testing was obtained from all patients. SkinTc concentrations did not differ significantly among patients suffering from cerebrovascular disease (CVD) and peripheral arterial disease (PAD) compared to the corresponding control groups and among patients with a calculated cardiovascular risk > 10% in 10 years compared to patients with a risk< 10% (all p > 0.05). Additionally, SkinTc concentrations were not significantly higher in the 245 patients with at least one documented atherosclerotic disease compared with the remaining 73 patients without evidence of atherosclerosis. In conclusion, SkinTc concentrations determined by the PREVU POC Skin Sterol Test are not related to the presence of CVD and PAD or to an elevated cardiovascular risk, indicating that this parameter cannot be used as a reliable indicator of atherosclerosis.

Introduction We evaluated the feasibility of multidetector CT angiography (MDCTA) in the examination of vertebral artery (VA) pathologies and correlated the results with those of color Doppler sonography (CDS).Methods In this retrospective cohort analysis, we identified 65 patients with suspected cerebrovascular disease, who underwent MDCTA and CDS of the supraaortic vessels within a maximum period of 1 month. We evaluated the feasibility and image quality of MDCTA in this indication, compared the value of reformatted images and axial source images in the grading of stenoses and correlated these results with those of CDS.Results The image quality of the MDCTA examination was classified as good in 64 patients (98.5%) and as moderate in 1 patient (1.5%). Axial source images and reformatted images agreed perfectly in terms of stenosis detection and grading as well as the detection of hypoplastic VAs (kappa=1). The correlation between MDCTA and CDS was moderate (kappa=0.56) in terms of stenosis detection and quantification and poor (kappa=0.35) in terms of detection of hypoplasia of the VA.Conclusion MDCTA is a feasible method for the evaluation of VA pathologies providing a good image quality. Image reformatting does not add any diagnostic value to the interpretation of axial source images. The correlation between MDCTA and CDS is only moderate, reflecting the clinically important limitations of CDS in this indication.

Subclavian vein thrombosis (SVT) is a rare but painful event, which is estimated to constitute 1–4% of all cases of deep vein thrombosis and includes the risk for recurrent thrombosis in 17%, pulmonary embolism in 25% and chronic post‐thrombotic symptoms in approximately 75% of cases [1Kommareddy A. Zaroukian M.H. Hassouna H.I. Upper extremity deep venous thrombosis.Semin Thromb Hemost. 2002; 28: 89-99Crossref PubMed Scopus (107) Google Scholar, 2Prandoni P. Polistena P. Bernardi E. Cogo A. Casara D. Verlato F. Angelini F. Simioni P. Signorini G.P. Benedetti L. Girolami A. Upper‐extremity deep vein thrombosis. Risk factors, diagnosis, and complications.Arch Intern Med. 1997; 157: 57-62Crossref PubMed Google Scholar, 3Blom J.W. Doggen C.J. Osanto S. Rosendaal F.R. Old and new risk factors for upper extremity deep venous thrombosis.J Thromb Haemost. 2005; 3: 2471-8Abstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar]. Primary idiopathic SVT accounts for up to 9% of events and includes the Paget–Schroetter syndrome or effort thrombosis and usually affects otherwise healthy and active persons [1Kommareddy A. Zaroukian M.H. Hassouna H.I. Upper extremity deep venous thrombosis.Semin Thromb Hemost. 2002; 28: 89-99Crossref PubMed Scopus (107) Google Scholar]. The key event leading to thrombosis in these patients is not very well understood at the moment and considering the potential complications, the early identification of patients at risk for SVT is of special interest and clinical relevance. Thus, we performed a prospective case control study and evaluated patients with idiopathic SVT by magnetic resonance imaging (MRI) of the subclavian fossa in order to identify anatomical risk constellations for the development of thrombosis, and additionally compared these results with those of clinical provocative tests. Between December 2001 and September 2003, 29 consecutive patients (13 male, 44.8%) with idiopathic SVT referred to a tertiary care university hospital were included in this case control study. A sex‐matched population of 29 patients, who underwent MRI because of suspected cervical discopathy and did not have a history of SVT or symptoms of thoracic outlet syndrome (TOS), served as the control group. MRI of both thoracic outlets of patients and controls was performed using a 1.5T scanner (Symphony; Siemens, Erlangen, Germany) and a neck‐array coil with the following sequences: sagittal and axial T1‐weighted Turbo spin echo images (TR:750, TE:13 ms) and coronal T2‐weighted Turbo spin echo images (TR:4530, TE:111 ms) with fat suppression with a field of view of 250 × 100 mm, a matrix of 384 × 288, a section thickness of 3 mm and an intersection gap of 0.3 mm. The sequences were performed first with the patient's arms alongside the body and again after a postural maneuver, while controls were solely investigated with arms alongside the body. The evaluations were performed on the sagittal T1‐weighted images by two musculoskeletal radiologists in accordance. Additionally, they analysed the amount of fat surrounding the subclavian vessels using a semi‐quantitative scale: A (no fat visible), B (thin fat margin of maximal 1 mm visible) and C (thick fat girdle). Finally, patients underwent clinical provocation tests. The study was approved by the local ethics committee and written informed consent was obtained from patients and controls. Student's t‐test, anova analyses and cross‐tables procedures were used for statistical analyses (spss 11.5; SPSS Inc., Chicago, IL, USA). For detailed analyses we built three groups, which included the 29 symptomatic (= with SVT) arm sides of patients (group 1), the 29 asymptomatic arm sides of patients (group 2) and the 58 arm sides of controls (group 3). A P‐value < 0.05 was considered as significant. Patients were significantly younger than controls (40.5 ± 13.1 years vs. 56.1 ± 15.6 years, P < 0.001), and the mean body mass index (BMI) was comparable (25.4 ± 4.5 vs. 26.0 ± 5.0; P > 0.05). SVT affected the dominant arm in 23 (79%) patients. Detailed information about the results of MRI and the clinical provocation tests are shown in the Table 1. In short, an aberrant muscle was detected originating from the cranial surface of the sternal end of the first rib, just dorsal to the origin of the subclavius muscle in eight (6.9%) shoulders. According to dissection studies this muscle is called musculus subclavius posticus (MSP) [5Akita K. Ibukuro K. Yamaguchi K. Heima S. Sato T. The subclavius posticus muscle: a factor in arterial, venous or brachial plexus compression?.Surg Radiol Anat. 2000; 22: 111-5Crossref PubMed Scopus (41) Google Scholar, 6Forcada P. Rodriguez‐Niedenfuhr M. Llusa M. Carrera A. Subclavius posticus muscle: supernumerary muscle as a potential cause for thoracic outlet syndrome.Clin Anat. 2001; 14: 55-7Crossref PubMed Scopus (29) Google Scholar]. No further anatomical variant was detected. After hyperabduction the minimum costoclavicular distance (MCD, defined as the minimum distance between the posterior border of the clavicle and the superior margin of the first rib) narrowed significantly from 13 ± 4 mm to 10 ± 3 mm (P < 0.001) and the maximum thickness of the subclavius muscle (MS) decreased significantly from 7 ± 2 mm to 5 ± 2 mm (P < 0.001) [4Demondion X. Bacqueville E. Paul C. Duquesnoy B. Hachulla E. Cotten A. Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations.Radiology. 2003; 227: 461-8Crossref PubMed Scopus (128) Google Scholar]. The analyses revealed that the MCD of both arm sides of patients was significantly more narrow compared with the controls’ arm sides (P < 0.001) and increased with the amount of fat surrounding the vessels (12 ± 3 mm, 16 ± 7 mm and 20 ± 5 for groups A, B and C; P < 0.05). The fat distribution was not significantly related to the BMI (P > 0.05). Finally, our analyses revealed no correlation between the results of the costoclavicular test and the measurements on the costoclavicular space by MRI, because there was no significant difference between negatively (n = 50) and positively (n = 8) tested arm sides concerning the MCD and the maximal thickness of the MS; all P > 0.05.Table 1Detailed results of magnetic resonance imaging and the clinical provocation tests distributed to the three arm side groups; group 1 (symptomatic arm side of patients), group 2 (asymptomatic arm side of patients) and group 3 (arm side of controls)Group 1 (n = 29)Group 2 (n = 29)Group 3 (n = 58)Musculus subclavius posticus4 (13.8%)1 (3.4%)3 (5.2%)Interscalene space narrowed3 (10.3%)3 (10.3%)7 (12.1%)Fat distribution Group A3 (10.3%)3 (10.3%)4 (6.9%) Group B22 (75.9%)22 (75.9%)36 (62.1%) Group C4 (13.8%)4 (13.8%)18 (31%)Costoclavicular test positive5 (17.2%)3 (10.3%)NAHyperabduction test positive17 (58.6%)18 (62.1%)NAMCD (mm)14 ± 514 ± 519 ± 5MCD, minimum costoclavicular distance; NA, not applicable. Open table in a new tab MCD, minimum costoclavicular distance; NA, not applicable. The present study is the first evaluating patients with idiopathic SVT by MRI. We detected the MSP, which had not been evaluated in vivo yet, in eight shoulders [5Akita K. Ibukuro K. Yamaguchi K. Heima S. Sato T. The subclavius posticus muscle: a factor in arterial, venous or brachial plexus compression?.Surg Radiol Anat. 2000; 22: 111-5Crossref PubMed Scopus (41) Google Scholar, 6Forcada P. Rodriguez‐Niedenfuhr M. Llusa M. Carrera A. Subclavius posticus muscle: supernumerary muscle as a potential cause for thoracic outlet syndrome.Clin Anat. 2001; 14: 55-7Crossref PubMed Scopus (29) Google Scholar]. The overall incidence of 7% of our study population corresponds well with the incidence of 9% reported by Akita et al. [5Akita K. Ibukuro K. Yamaguchi K. Heima S. Sato T. The subclavius posticus muscle: a factor in arterial, venous or brachial plexus compression?.Surg Radiol Anat. 2000; 22: 111-5Crossref PubMed Scopus (41) Google Scholar] in their dissection population, which was asymptomatic for TOS or SVT, indicating that MRI could accurately evaluate this muscle variant. However, a major role of the MSP in the development of SVT is unlikely, because one would expect a significantly higher incidence in the symptomatic patient group [5Akita K. Ibukuro K. Yamaguchi K. Heima S. Sato T. The subclavius posticus muscle: a factor in arterial, venous or brachial plexus compression?.Surg Radiol Anat. 2000; 22: 111-5Crossref PubMed Scopus (41) Google Scholar, 6Forcada P. Rodriguez‐Niedenfuhr M. Llusa M. Carrera A. Subclavius posticus muscle: supernumerary muscle as a potential cause for thoracic outlet syndrome.Clin Anat. 2001; 14: 55-7Crossref PubMed Scopus (29) Google Scholar]. In accordance with the literature, we detected a significantly narrowed MCD in patients compared with controls and additionally demonstrated that patients with less fat surrounding the subclavian vessels exhibit a smaller MCD [4Demondion X. Bacqueville E. Paul C. Duquesnoy B. Hachulla E. Cotten A. Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations.Radiology. 2003; 227: 461-8Crossref PubMed Scopus (128) Google Scholar]. The relationship between fat distribution and MCD has not been reported yet and might explain the observation of Joffe et al. [7Joffe H.V. Kucher N. Tapson V.F. Goldhaber S.Z. Deep vein thrombosis (DVT) FREE Steering Committee. Upper‐extremity deep vein thrombosis: a prospective registry of 592 patients.Circulation. 2004; 110: 1605-11Crossref PubMed Scopus (316) Google Scholar], who demonstrated that patients with idiopathic SVT had a lower body mass index (BMI) than the lower‐extremity deep vein thrombosis patients. Furthermore, clinical provocation tests yielded a low sensitivity and specificity in the detection of symptomatic arm sides and positive clinical tests exhibited no anatomical correlates evaluated by MRI [8Plewa M.C. Delinger M. The false‐positive rate of thoracic outlet syndrome shoulder maneuvers in healthy subjects.Acad Emerg Med. 1998; 5: 337-42Crossref PubMed Google Scholar]. A limitation of the present trial was the relatively small number of arm sides with SVT, but this is a rare condition and idiopathic thromboses occur even more infrequently. A further potential limitation of the present study is missing MR‐angiography and MR‐venography studies, but the primary aim of the study was to evaluate the perivascular anatomy of the subclavian fossa. In conclusion, patients with idiopathic SVT had a smaller MCD than healthy controls. The MCD is related to the amount of fat surrounding the subclavian vessels, which might contribute to the observation that patients with idiopathic SVT are frequently thin and otherwise healthy. The dominant arm side was affected in 80% of patients, supporting the hypothesis that SVT results from excessive use of the involved arm by predisposed individuals. We failed to identify common anatomical variations in patients suffering from SVT. The authors state that they have no conflict of interest. We thank M. Haumer, M. Breitenseher and S. Sabeti for their scientific input and support.

BACKGROUND While the literature has conclusively shown a significant decrease of plasma lipids after intake of HMG-CoA reductase inhibitors, there is no detailed information provided about their effects on the body fat status. PATIENTS AND METHODS We performed a retrospective analysis of a prospective randomized controlled trial including consecutive patients with suspected arterial occlusive disease. Normolipidemic patients served as the control group and hyperlipidemic patients were randomized to either 20 mg atorvastatin or to 40 mg simvastatin. At baseline, after 6 weeks and after 6 months we assessed the relative body fat, the waist circumference and the body mass index (BMI) as well as plasma total cholesterol (chol), low-densitiy lipoprotein cholesterol (LDL) and triglycerides (TG). RESULTS In total we included 129 patients in our analysis. The body fat status remained unchanged in the control group as well as in the atorvastatin group (all p > 0.05) for the whole study period, while simvastatin treatment led to a slight, but significant increase of the relative body fat (+ 4.2%) between the 6 weeks and 6 months assessment (p = 0.013). CONCLUSIONS Long-term intake of statins seems to have no positive influence on parameters of the body fat status and therefore misses one important goal in the cardiovascular risk prevention.

BACKGROUND:Skin cholesterol (SkC) has been suggested to be an additional risk predictor, so we evaluated the test performance, potential determinants of this marker as well as a potential correlation of SkC with markers of inflammation and the history of cardiovascular events.PATIENTS AND METHODS:SkC, determined by the non-invasive PREVU POC Skin Sterol test, as well as serum lipids, the body fat status, high-sensitive CRP (hs-CRP) and serum amyloid A (SAA) were evaluated in consecutive patients with and without documented atherosclerotic disease.RESULTS:SkC was assessed in 201 patients. The within-day precision (CV) was 3.8%, the day-to-day CV of the right hand was 8.6% and 4.3% for the left hand, respectively. Neither univariate analysis nor multiple regressions identified a significant influence of age, sex, serum lipids, body fat status, smoking or diabetes mellitus on SkC, corresponding results were observed in a further analysis including 174 of these patients concerning hs-CRP and SAA (all p > 0.05). T-test analyses detected no significant differences between patients with and without a history of coronary, peripheral vascular and cerebrovascular events (all p > 0.05).CONCLUSIONS:The PREVU POC Skin Sterol test for the assessment of SkC proved an acceptable test performance. SkC is independent from serum lipids, traditional cardiovascular risk factors, two sensitive markers of systemic inflammation as well as the history of cardiovascular events indicating that the perception of this parameter as an established marker of vascular disease is premature.

Ziele: Der Bericht von den Ergebnissen der endovaskulären Behandlung von inflammatorischen Aortenaneurysmen (IAA). Methode: Eine umfassende Suche der Literatur nach Studien die über endovaskuläre Behandlung von IAAs berichten wurde durchgeführt. Alle Studien die einen minimalen Beobachtungszeitraum von 6 Monaten hatten, über primären technischen Erfolg, Komplikationen, langzeit Mortalität und reinterventionsrate berichteten wurden ausgewählt. Zusätzlich müssten die Studien auch über mindestens einen der 3 Kontrollparameter, Aneurysmasack Diameter, periaortische Fibrose und potenzielle Nierenbeteiligung berichten um in die Analyse miteinbezogen zu werden. Die Auswahl der Studien und die Auswertung der Kriterien wurde von zwei unabhängigen Beobachtern durchgeführt. Ergebnis: Vierzehn Studien mit 46 Patienten wurden eingeschlossen (45 Männer, mittleres Alter 65 Jahre) mit einer durchschnittlichen Beobachtungszeit von 18 Monaten. Der primäre technische Erfolg war 95,6%. Die mediane Regression des Aneurysma Durchmessers war 11mm, von 43 Patienten die eine PAF vor der Intervention hatten zeigten 22 (47,8%) eine komplette Regression, 18 (39,1%) blieben unverändert und 3 (13,1%) zeigten eine Progression nach der endovaskulären Behandlung. Eine renale Beteiligung bildete sich in 12 der 24 Patienten (50%) komplett zurück. Reinterventionen wurden in 8 Patienten berichtet, die interventionsbezogene Mortalität war 0% und die allgemeine Mortalität während des Beobachtungszeitraumes war 13,0%. Schlussfolgerung: Die endovaskuläre Behandlung von IAAs exkludiert erfolgreich das Aneurysma, reduziert in den meisten Patienten die PAF und die renale Beteiligung, hat eine geringe mortalitäts- und akzeptable reintrventionsrate.

Ziele: Ziel der Studie war es, die Genauigkeit von B-Flow imaging (BFI) in der Charakterisierung von Plaques der A. carotis interna (ACI) im Vergleich zu B-mode und Farbduplex (CDI) Analyse zu evaluieren. Die Ergebnisse der histopathologischen Auswertung der explantierten Plaques dienten als Goldstandard. Methode: 28 konsekutive Patienten mit hochgradiger ACI Stenose, welche zur Carotis-Endarterektomie vorgesehen waren, wurden in diese prospektive Pilot-Studie eingeschlossen. Anhand der BFI, B-mode und CDI Bilder wurden die Plaques nach standardisierten Scores nach Beletsky und der American Heart Association (AHA) klassifiziert, der mittlere Grauwert (GSM) bestimmt und das Vorhandensein von Ulcerationen evaluiert; die Übereinstimmung mit der histopathologischen Auswertung wurde berechnet. Ergebnis: Basierend auf der Klassifikation von Beletsky stimmten BFI und Pathologie in 21 (75%, κ=0.61, P<0.001) Patienten überein. Die korrespondierenden Resultate für die AHA Klassifikation ergaben eine geringere Übereinstimmung für BFI (19 Patienten/68%, κ=0.38, P=0.003). Die Messungen des GSM mittels BFI und B-mode korrelierten signifikant (r=0.95, P<0.001), der mediane BFI-GSM der symptomatischen Patienten war 24 (IQR 52) und 40 (IQR 51) für die asymptomatischen Patienten. Die Sensitvität des BFI für die Detektion von ulcerierten Plaques war 100%, die Spezifität 95.8%, korrespondierende Werte für CDI waren 100% bzw. 92.7%. Schlussfolgerung: BFI bietet eine moderate Korrelation mit den Ergebnissen der histopathologischen Auswertung, eine verlässliche Bestimmung des GSM und ist äußerst sensitive für die Detektion von ulcerierten Plaques.

OBJECTIVE Our objective was to report the long-term follow-up results of endovascular aneurysm repair of inflammatory aortic aneurysms. CONCLUSION Endovascular aneurysm repair of inflammatory aortic aneurysms excludes the aneurysm and seems to reduce the size of the aneurysmal sac and the extent of periaortic fibrosis with acceptable periinterventional and long-term morbidity.

Background and Purpose— Plaque characteristics are suggested to play a potentially important role as risk factors for poor outcome after carotid artery stenting (CAS). We therefore correlated objectively and subjectively determined carotid plaque morphology with neurological complications after CAS. Methods— We enrolled 698 consecutive patients undergoing elective CAS from a prospective single-center registry database and classified the preinterventional plaque status according to gray-scale median levels and the standardized Beletsky and Gray-Weale plaque scores. Patients were followed for 30-day neurological complications. Results— Neurological complications including transient ischemic attack, minor and major stroke occurred in 5.9% (41/698) of the patients. Median gray-scale median, Beletsky and Gray-Weale scores were 45 (interquartile range [IQR] 25 to 70), 3.0 (IQR 2.0 to 3.0) and 2.0 (IQR 2.0 to 3.0), respectively. None of the scores was significantly associated with adverse outcome adjusting for traditional risk factors, medication, preinterventional symptoms, degree of stenosis, contralateral occlusion and use of cerebral protection, neither with respect to all neurological complications nor with respect to stroke and death (all P >0.05). Conclusions— Plaque echolucency measured by objective and subjective grading did not identify patients with an increased risk of peri-interventional neurological events. Evaluation of plaque echolucency therefore cannot be recommended for risk stratification in CAS patients.

A 64-year-old man suffering from several episodes of transient ischemic attack with weakness of his left arm and leg was referred to the department of radiology. Pre-interventional work-up included cranial MRI, indicating several lacunar spots in the right-sided subcortical and periventricular white matter without signs of cytotoxic edema as an indicator of acute ischemia (images not shown). MR perfusion imaging uses a dynamic, T2*-weighted echo-planar fast-field echo susceptibility sequence in the axial orientation with intra-venous contrast enhancement. The standardized time-to-peak (stdTTP) measurement provides a quantitative measure of the hemodynamic situation of the brain and has been shown as significantly increased with higher grades of stenotic or occlusive carotid artery disease. 1 Nasel C. Kronsteiner N. Schindler E. Kreuzer S. Gentzsch S. Standardized time to peak in ischemic and regular cerebral tissue measured with perfusion MR imaging. AJNR Am J Neuroradiol. 2004; 25: 945-950 PubMed Google Scholar , 2 Nasel C. Azizi A. Wilfort A. Mallek R. Schindler E. Measurement of time-to-peak parameter by use of a new standardization method in patients with stenotic or occlusive disease of the carotid artery. AJNR Am J Neuroradiol. 2001; 22: 1056-1061 PubMed Google Scholar A stdTTP ≤3.5 seconds is reported to be regular, and evidence suggests that an stdTTP ≥7 seconds indicates critically perfused tissue. 1 Nasel C. Kronsteiner N. Schindler E. Kreuzer S. Gentzsch S. Standardized time to peak in ischemic and regular cerebral tissue measured with perfusion MR imaging. AJNR Am J Neuroradiol. 2004; 25: 945-950 PubMed Google Scholar , 2 Nasel C. Azizi A. Wilfort A. Mallek R. Schindler E. Measurement of time-to-peak parameter by use of a new standardization method in patients with stenotic or occlusive disease of the carotid artery. AJNR Am J Neuroradiol. 2001; 22: 1056-1061 PubMed Google Scholar In this patient, MR perfusion imaging showed a severe hypoperfusion in the corresponding vascular territory of the right middle cerebral artery (Figure 1b). Pre-interventional color Doppler ultrasound (images not shown) and intra-arterial digital subtraction angiography (Figure 1a) revealed a right-sided high-grade internal carotid artery stenosis, which was successfully treated by protected carotid artery stenting with a good angiographic outcome (Figure 2a). Post-interventional MRI, performed 2 days after stent placement, showed no signs of cytotoxic edema as an indicator of relevant peri-interventional cerebral embolism and a restoration of regular, symmetric perfusion (see Figure 2b). These images suggest that carotid artery stenting can not only protect cerebral embolism from plaque material of internal carotid artery stenosis, but can also improve pre-existent cerebral hypoperfusion. Figure 2Intra-arterial digital subtraction angiography (a) after successful stent implantation in the same patient with a good angiographic outcome and corresponding magnetic resonance perfusion map (obtained 2 days post-interventionally) of the brain (b) indicating restored regular, symmetric perfusion of both hemispheres. View Large Image Figure Viewer