Der Schlaganfall ist weltweit die dritthäufigste Todesursache und die häufigste Ursache für eine schwere Behinderung im Erwachsenenalter. Jedes Jahr erkranken in Österreich rund 20.000 Menschen daran, etwa 60.000 leiden unter den Schlaganfallfolgen. Neue Erkenntnisse zur Pathophysiologie und Klinik des Schlaganfalls sowie die Einführung moderner diagnostischer Verfahren haben das Management von Schlaganfallpatienten wesentlich geändert.

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.

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: 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.

Percutaneous transluminal angioplasty, with stenting (PTAS) has become a treatment option for severe carotid stenosis. The goal of our study was to determine prospectively neurocognitive outcome 6 months after unilateral stent-protected carotid angioplasty. Twenty consecutive patients who underwent stent-protected angioplasty for symptomatic (n=9) or asymptomatic (n=11) high-grade carotid stenosis were investigated and compared to an age and disease matched control group. Patients were administered preprocedurally and 6 months postprocedurally a battery of neuropsychological tests. We used reliable change indices methodology in order to control for practice and statistical effects unrelated to intervention. We found no cognitive change in approximately 90% of patients and cognitive improvement in approximately 10% of patients for concentration and attention variables. We further found no cognitive change in 61% of patients, cognitive improvement in 11% of patients and cognitive deterioration in 28% of patients for psychomotor speed. No cognitive change in 94% of patients and cognitive deterioration in 6% of patients was found for sustained attention; no cognitive change in 80% of patients, cognitive improvement in 15% of patients and cognitive deterioration in 5% of patients was found for verbal fluency; no cognitive change in 100% of patients was found for interference (Stroop test): no cognitive change in 95% of patients, cognitive improvement in 5% of patients was found for interference (c.I test), respectively.Our study showed that 6 months after PTAS cognitive functioning did not change in most patients significantly. For some patients, however, significant improvement or deterioration in single neurocognitive domains can be expected. The reasons for these changes are unclear but may depend on variable type; magnitude of microemboli production; right vs. left cerebral vasculature, respectively.

Background: In patients with a first symptomatic pulmonary embolism (PE), the risk of recurrence is unknown. We therefore investigated the risk of recurrence among patients with spontaneous symptomatic PE and among those with deep vein thrombosis (DVT) without symptoms of PE.Methods: After discontinuation of secondary thromboprophylaxis for a first venous thromboembolism (VTE), we prospectively observed 436 patients for an average of 30 months. Patients with secondary VTE, natural inhibitor deficiencies, lupus anticoagulant, cancer, long-term antithrombotic therapy, vena cava filters, or pregnancy were excluded. The study outcome was objectively documented recurrent symptomatic VTE.Results: Recurrent VTE was seen among 28 (17.3%) of 162 patients with symptomatic PE and among 26 (9.5%) of 274 patients with DVT without symptoms of PE. Compared with patients with DVT, the relative risk of recurrent VTE among patients with symptomatic PE was 2.2 (95% confidence interval, 1.3-3.7; P = .005). The relative risk was not affected by age, sex, presence of factor V Leiden or prothrombin G20210A, hyperhomocysteinemia, or high factor VIII levels. Compared with patients with DVT without symptoms of PE, patients with symptomatic PE had an adjusted relative risk of PE at recurrence of 4-0 (95% confidence interval, 1.3-12.3; P = .03).Conclusion: Patients with a first symptomatic PE not only have a higher risk of recurrent VTE than those with DVT without symptoms of PE, but are also at high risk of symptomatic PE at recurrence.

Ziele: Ziel dieser prospektiven Pilotstudie war es, die Wertigkeit von B-Flow, einem neuentwickelten Ultraschallverfahren zur direkten Blutflussdetektion in Grauwerten, in der Evaluierung des Stenosegrades der Arteria carotis interna (ACI) zu evaluieren. Methode: 28 Patienten mit einer bekannten Stenose der ACI (30%-99%) wurden zuerst mittels farbkodierter Duplexsonographie, danach mittels B-Flow untersucht. Wir analysierten die Korrelation der B-Flowparameter (Länge und Fläche des Jetflusses, Grauwertintensität in der ACI und eine Grauwertratio) mit Duplexparametern (systolischer Spitzenfluss in der ACI, Carotid Ratio, Stenosegrad in Prozent). Ergebnis: Trotz exzellenter Interobserverübereinstimmung zeigte keiner der untersuchten B-Flowparamter eine signifikante Korrelation mit den Duplexparametern. (Pearson's r=-0,28–0,03). Schlussfolgerung: Basierend auf unseren Ergebnissen können die untersuchten B-Flowparameter nicht in der Evaluierung des Stenosegrades der ACI verwendet werden.

Interventionelle Therapie der peripheren arteriellen VerschlusskrankheitStellenwert der endovaskulären Brachytherapie in der interventionellen Therapie der peripheren arteriellen VerschlusskrankheitMinarMinar Allgemeines Krankenhaus Wien, Abteilung Angiologie, Wien Search for more papers by this authorPublished OnlineMarch 14, 2013https://doi.org/10.1024/0301-1526.33.S64.65PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInReddit SectionsMoreFiguresReferencesRelatedDetailsCited byPeripheral arterial occlusive disease (PAOD)4 January 2018 | Phlebologie, Vol. 43, No. 06Intravaskul?re Brachytherapie bei peripherer arterieller Verschlusskrankheit: Systematische ?bersicht zur medizinischen Wirksamkeit und gesundheits?konomische ModellierungZeitschrift f?r Evidenz, Fortbildung und Qualit?t im Gesundheitswesen, Vol. 103, No. 6 Volume 33Issue Supplement 64February 2004ISSN: 0301-1526eISSN: 1664-2872 tabs.informationVasa (2013), 33, pp. 65-72 https://doi.org/10.1024/0301-1526.33.S64.65.© 2013Hogrefe AGPDF download

Purpose: Superficial vein thrombosis (SVT), which can be managed sufficiently with compressive bandage and locally applied or systemic nonsteroidal antiphlogistics, is generally considered as being rela- tively harmless. However, the SVT can spread into the deep vein system necessitating other more aggressive surgical and/or systemic treatment. In this randomis- ed, controlled, open, multicentre, comparative study, the efficacy and tolerability of a new galenic formula- tion of liposomal heparin-spraygel was compared with subcutaneously administered low molecular weight heparin. Methods: 42 patients (31 female, 11 male), diagnosed with superficial vein thrombosis confirmed by duplex sonography, were entered. All patients got a compressive therapy and were permitted to use paracetamol (1000 mg per day) as pain rescue medication. The treatment results were assessed after seven or fourteen days of therapy. The primary end points were reduction of pain (VAS, VRS), ery- thema (planimetry) and swelling (ordinal scale). At each visit the length of thrombus (mm) was measured by duplex sonography. Results: None of the 42 patients developed a deep ve- nous thrombosis. The results of the pain evaluation (VAS evaluation) showed a comparable pain reduction in both groups. The consumption of rescue medication was also comparable. Erythema and thrombus size showed a con- tinuous decrease in both groups without any significant difference. Conclusion: The topical application of liposomal heparin-spraygel in combination with compressive therapy showed a comparable efficacy profile to the sub- cutaneously applied low molecular weight heparin in the treatment of superficial vein thrombosis. Kurzfassung: Liposomales Heparin-Spraygel im Vergleich zu subkutanem niedermolekularem Heparin bei Patienten mit oberflachlicher Venen- thrombose. Eine randomisierte, kontrollierte, offene Multicenter-Studie. Ziel: Die oberflachliche Venenthrombose (superficial vein thrombosis, SVT), die durch Kompressionsbehandlung sowie lokal ange- wandte oder systemische nichtsteroidale Antiphlo- gistika hinreichend behandelt werden kann, wird ge- nerell als relativ harmlos eingestuft. Allerdings kann eine SVT auch tiefer gehen, was eine aggressivere chirurgische und/oder systemische Behandlung notig macht. In der vorliegenden randomisierten, kontrollier- ten, offenen, multizentrischen Vergleichsstudie wur- den Wirkung und Toleranz des neuen galenischen liposomalen Heparin-Spraygels mit subkutan verab- reichtem niedermolekularem Heparin verglichen. Methodik: 42 Patienten (31 Frauen, 11 Manner) mit diagnostizierter SVT, mittels Duplex-Sonographie besta- tigt, wurden eingeschlossen. Alle Patienten erhielten eine Kompressionstherapie, daruber hinaus war es ihnen er- laubt, Paracetamol (1000 mg/Tag) als Schmerzhemmer einzunehmen. Die Behandlungsergebnisse wurden nach 7 oder 14 Tagen uberpruft. Die primaren Endpunkte um- fasten Schmerzreduktion (VAS, VRS), Erythema (Planime- trie) und Schwellung (ordinale Skala). Bei jeder Visite wur- de die Lange des Thrombus (mm) mittels Duplex-Sono- graphie gemessen. Ergebnisse: Keiner der 42 Patienten entwickelte eine tiefe Venenthrombose. Das Ergebnis der Schmerz- evaluierung (VAS-Evaluation) zeigte eine vergleichbare Schmerzreduktion in beiden Gruppen. Der Medikamen- tenkonsum war ebenfalls vergleichbar. Erythema und Thrombengrose zeigten einen kontinuierlichen Anstieg in beiden Gruppen, ohne signifikante Unterschiede. Schlusfolgerung: Die topische Anwendung von liposo- malem Heparin-Spraygel mit Kompressionstherapie zeig- te in der Behandlung oberflachlicher Venenthrombosen eine vergleichbare Wirkung zum subkutan verabreichten niedermolekularen Heparin. J Kardiol 2003; 10: 375-8.

Background: In patients suffering from peripheral arterial occlusive disease (PAOD) the risk of restenosis after percutaneous transluminal angioplasty ( PTA) might be influenced by platelet mediated factors. Objective: To look for a correlation between the effect of antiplatelet therapy and recurrence of disease after PTA by monitoring platelet function in 3-month intervals by the platelet function analyzer system, PFA-100(R), over a period of 1 year. Patients and methods: A group of 98 patients (43 females, 55 males) with PAOD, treated with aspirin (n = 52), thienopyridine (n = 34) or combination therapy of both (n = 12) were followed over a period of 12 months after elective PTA of the lower extremities with regard to occurrence of restenosis or reocclusion at the site of angioplasty, to demonstrate inhibitory effects on platelets, induced by antiplatelet therapy. Results: PFA-100 proved suitable to identify 'non-responders' to antiplatelet therapy, in a 12-month follow-up period. In 'non-responders' to clopidogrel therapy, a higher incidence of restenosis or reocclusion after PTA of the lower limbs was detected compared with 'responders'. Conclusion: PFA-100, upon stimulation with ADP, might predict patients under clopidogrel therapy with elevated risk for the development of complications following PTA of the lower limbs. This could offer the chance to switch to an alternative therapy or adapt the dose.

Objective: Patients with peripheral arterial occlusive disease are prone to soft tissue infections and frequently require antibiotics. To date, however, it is not known whether improvement of arterial blood flow by angioplasty of stenosis increases antibiotic concentrations in ischemic lesions.Patients and methods: All patients were scheduled to undergo elective percutaneous transluminal angioplasty (n = 10). Following a single, 400-mg dose of ciprofloxacin, drug concentrations in plasma, ischemic and healthy soft tissue; arterial peak systolic velocity; and ankle-brachial pressure index were assessed before and after angioplasty. Unbound ciprofloxacin concentrations were measured at the site of infection with use of in vivo microdialysis.Results: Angioplasty increased peak systolic velocity and ankle-brachial pressure index compared with baseline (P < .002). Before angioplasty area under concentration-time curve (AUC(0.300)) values for ciprofloxacin were lower in ischemic tissue than in healthy tissue, with median values of 7.1 mg.h/L (range, 3.5-13.0) and 11.3 mg.h/L (range, 3.4-19.0), respectively (P = .03). After angioplasty AUC(0.300) values were identical in ischemic and healthy adipose tissue; median AUC(0.300) values were 8.0 mg.h/L (range, 4.0-20.7) and 8.5 mg.h/L (range, 4.4-22.9), respectively (P = .7). A combined in vivo pharmacokinetic/in vitro pharmacodynamic simulation based on tissue concentration data indicates that this difference in pharmacokinetics is also reflected in antimicrobial effect.Conclusion: Antibiotic concentrations are reduced significantly in ischemic lesions compared to those of healthy adipose tissue in patients with peripheral arterial occlusive disease. From the present data it might be speculated that improvement of arterial blood flow at the affected extremity is associated with increased cure rates of soft tissue infections in these patients.

We report about a patient suffering from multiple spastic stenoses of varying degree of both iliac arteries and from occlusion of the left tibiofibular trunc. Laboratory investigations revealed increased levels of homocysteine and the diagnosis of homocystinuria was confirmed by fibroblast cell culture. The spasms responded well to vasodilative therapy with nitroglycerine, molsidomine (cGMP mediated) and prostaglandine E1 but not with nifedipine (Ca influx blocker). Our review of literature demonstrated that this arterial spastic abnormality is a very rare complication in patients suffering from homocystinuria.

A G20210A transition in the prothrombin gene is a common risk factor of venous thrombosis. The risk of recurrent venous thromboembolism in carriers of the 20210A allele is unknown and guidelines for secondary thromboprophylaxis in these patients are not available. In a prospective multicenter trial, 492 patients with a history of objectively documented venous thromboembolism were followed for a mean observation time of 24+/-16 months after discontinuation of oral anticoagulants. Forty-two patients (8.5%) were carriers of the 20210A allele. Three of the 42 patients with the G20210A mutation (7%) and 54 of 450 patients without the mutation (12%) experienced recurrent venous thrombosis. At 24 months, the probability of recurrence was 8% (95% CI 0-16.7) in patients with the mutation and was 12.2% (95% CI 8.8-15.6) in patients without the mutation. In conclusion, the risk of early recurrent venous thromboembolism is not higher in patients with the G20210A mutation than in those without the mutation. Therefore, long-term secondary thromboprophylaxis with oral anticoagulants in heterozygous carriers of the 20210A allele is not justified.

Interstitial ciprofloxacin concentrations were measured by microdialysis in inflamed foot lesions of non-insulin-dependent diabetes mellitus patients following intravenous administration of 0. 2 g of ciprofloxacin. Interstitial ciprofloxacin concentrations were significantly lower than corresponding serum concentrations. There was no significant difference in the penetration of ciprofloxacin into inflamed and unaffected tissue (area under the concentration-time curve(infection)/area under the concentration-time curve(unaffected tissue) = 0.99 +/- 0.15 [mean +/- standard error], n = 6). Thus, inflammation appears to have little or no effect on the penetration of ciprofloxacin into tissue.