[A male patient with acute, reversible blindness]. / Een man met acute, reversibele blindheid.

BACKGROUND: Intra-arterial thrombectomy (IAT) in occlusions of the posterior cerebral artery (PCA) is uncommon and not a proven therapeutic solution, but can be performed in individual cases. CASE DESCRIPTION: An 80 year old man visited the emergency room after experiencing acute blindness. This was caused by a new hemianopia for the left visual field due to an occlusion of the right PCA, on top of a pre-existing hemianopia for the right visual field. Auxiliary testing showed an old ischemic stroke of the right occipital lobe, and a new occlusion of the right PCA. After deliberation with the patient, it was decided to perform IAT, because of the debilitating effect of the current neurological disabilities. IAT was succesfull and the patient completely recovered to the pre-existing level of functioning. CONCLUSION: Although there is no indisputable evidence to suggest that IAT in occlusions of the PCA is safe and effective, this case illustrates that IAT can be considered on an individual basis. Based on individual patient characteristics and shared decision making, IAT can be performed after carefull consideration of the risks and benefits.

Secondary interventions in patients with autologous infrainguinal bypass grafts strongly improve patency rates.

OBJECTIVE: To describe the patency of percutaneous transluminal angioplasty (PTA) of autologous infrainguinal bypasses at risk. METHODS: This was a retrospective single-center cohort study of consecutive patients who underwent primary PTA of an infrainguinal autologous bypass at risk from January 2009 to December 2013. Duplex ultrasound surveillance was performed for at least 1 year after PTA. The primary study end point was the number of secondary interventions. Secondary end points were freedom from recurrent stenosis or bypass occlusion and the patency of the infrainguinal autologous bypass at 1 year after primary PTA. RESULTS: A total of 69 infrainguinal bypasses at risk in 69 patients were identified and treated with PTA. Technical success was achieved in 91%. The median follow-up was 17 months (range, 1-58 months). During follow-up, 30 bypasses (43%) remained free of significant stenosis or bypass occlusion, 29 bypasses (42%) developed recurrent stenosis, and 10 bypasses (14%) occluded. Rates of primary assisted, and secondary patency at 1 year were 84%, and 86%. Five (7%) major amputations were performed, all after bypass occlusion. CONCLUSIONS: Secondary interventions after PTA of a bypass at risk are common. However, repeated secondary interventions of autologous infrainguinal bypasses at risk result in patency rates of more than 80% at 1 year.