In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).

Surgical reconstruction is a satisfactory therapeutic choice for EICA, even when located at the base of the skull.

Q fever is a zoonotic disease caused by Coxiella burnetii. Polymorphic, the disease may present as an acute or chronic infection. Vascular infections are the second most common form of chronic Q fever, following endocarditis. Herein, we studied the outcome of 30 new cases of aortic infection caused by C. burnetii using uni- and multivariate analyses. The outcome of ten cases previously reported by our team was also updated. Of these 40 patients, 32 had a follow-up of >or=3 years. Among them, the overall mortality was of 25% (8/32). Vascular rupture was significantly and independently (multivariate P=0.03) associated with a lethal issue, whereas vascular surgery was significantly associated with recovery (uni- and multivariate P<0.01). Our findings demonstrate the critical importance of surgery in the management of C. burnetii vascular infections.

The most frequent clinical presentation of chronic Q fever is endocarditis, although infections of aneurysms and vascular prostheses have also been described. We report seven new cases of Coxiella burnetii infection of aneurysms or vascular grafts. We also review the literature and compare our cases with the six previously reported cases. This study demonstrated the lack of specific symptoms associated with this disease. Moreover, prospectively, in an attempt to reevaluate the incidence of Q fever-associated vascular infection, we systematically searched for C. burnetii infections in 163 patients with aortic aneurysms or vascular grafts who underwent vascular surgery. Microbiological testing included standard culture, Q fever serology, cell culture, and polymerase chain reaction amplification of C. burnetii DNA from biopsy specimens of aneurysms or vascular grafts. A microorganism was isolated from 25 patients, including C. burnetii in two cases; both of these patients had serological titers consistent with chronic Q fever. Both patients had nonspecific clinical features, and thus their infections would have probably remained undiagnosed without our systematic testing. Therefore, since the incidence of C. burnetii vascular infection is probably underestimated, we suggest that C. burnetii serology be routinely carried out in cases of unexplained febrile illness, pain, or weight loss in patients with a history of underlying vascular disease.

The purpose of this paper was to revisit the old concept of cannabis arteritis first described in the 1960s and report 10 new cases. Ten male patients, with a median age of 23.7 years developed subacute distal ischemia of lower or upper limbs, leading to necrosis in the toes and/or fingers and sometimes to distal limb gangrene. Two of the patients also presented with venous thrombosis and three patients were suffering from a recent Raynaud's phenomenon. Biological test results did not show evidence of the classical vascular risk factors for thrombosis. Arteriographic evaluation in all cases revealed distal abnormalities in the arteries of feet, legs, forearms, and hands resembling those of Buerger's disease. A collateral circulation sometimes with opacification of the vasa nervorum was noted. In some cases, arterial proximal atherosclerotic lesions and venous thrombosis were observed. All patients were moderate tobacco smokers and regular cannabis users. Despite treatment with ilomedine and heparin in all cases, five amputations were necessary in four patients. The vasoconstrictor effect of cannabis on the vascular system has been known for a long time. It has been shown that delta-8- and delta-9-tetrahydrocanabinols may induce peripheral vasoconstrictor activity. Cannabis arteritis resembles Buerger's disease, but patients were moderate tobacco smokers and regular cannabis users. These cases show that prolonged use of cannabis could be an additive risk factor for juvenile and young adult arteritis. Cannabis arteritis is a forgotten and severe occlusive vascular disease occurring in young adults. Search for cannabis use may be an important tool for a better knowledge of arteritis in young smokers.

all three techniques appear suitable for measuring stenosis of the proximal internal carotid when compared to DSA.

Aims:The deleterious nature of peripheral arterial disease (PAD) is compounded by a status of underdiagnosed and undertreated disease. We evaluated the prevalence and predictive factors of PAD in high-risk patients using the ankle-brachial index (ABI).Methods:The ABI was measured by general practitioners in France (May 2005–February 2006) in 5679 adults aged 55 years or older and considered at high risk. The primary outcome was prevalence of PAD (ABI strictly below 0.90).Results:In all, 21.3% patients had signs or symptoms suggestive of PAD, 42.1% had previous history of atherothrombotic disease and 36.6% had two or more cardiovascular risk factors. Prevalence of PAD was 27.8% overall, ranging from 10.4% in patients with cardiovascular risk factors only to approximately 38% in each other subgroup. Prevalence differed depending on the localization of atherothrombotic events: it was 57.1–75.0% in patients with past history of symptomatic PAD; 24.6–31.1% in those who had experienced cerebrovascular and/or coronary events. Regarding the classical cardiovascular risk factors, PAD was more frequent when smoking and hypercholesterolemia history were reported. PAD prevalence was also higher in patients with history of abdominal aortic aneurysm, renal hypertension or atherothrombotic event. Intermittent claudication, lack of one pulse in the lower limbs, smoking, diabetes and renovascular hypertension were the main factors predictive of low ABI.Conclusions:Given the elevated prevalence of PAD in high-risk patients and easiness of diagnosis using ABI in primary care, undoubtedly better awareness would help preserve individual cardiovascular health and achieve public health goals.

In patients with residual cervical ICA stenosis after IVT, we achieved full patency of the occluded artery and good functional prognosis at 3 months in all cases. We advocate for an extremely close monitoring of the blood pressure in the pre-, peri- and post-operative course and a close collaboration between neurologist and surgeon to determine the best timing for CEA.