bluuebunny/crossref_metadata_2025 huggingface dataset:
Considering critical methods and theoretical lenses in digital religion studies
Authors: Lövheim Mia , Campbell Heidi A
Published: January 2017

This article introduces a special issue on critical methods and theoretical lenses in Digital Religion studies, through contextualising them within research trajectories found in this emerging field. By starting from the assertion that current “fourth-wave of research on religion and the Internet,” is focused on how religious actors negotiate the relationships between multiple spheres of their online and offline lives, article authors spotlight key theoretical discussions and methodological approaches occurring within this interdisciplinary area of inquiry. It concludes with notable methodological and theoretical challenges in need of further exploration. Together it demonstrates how religion is practiced and reimagined within digital media spaces, and how such analysis can contribute to broader understanding of the social and cultural changes new media technologies are facilitating within society.
Enterprise and entrepreneurship on islands and remote rural environments
Authors: Burnett Kathryn A , Danson Mike
Published: January 2017

Although there has been increasing interest in rural enterprises, relatively little has been written on enterprise and entrepreneurship on islands where problems tend to be different, additional and exaggerated. Economic and cultural development agencies intervene to support such remote and isolated communities but the significance of the dominant metropolitan paradigm in the peripheralization of those establishing and running businesses on islands needs critiqued. This article contrasts experiences but highlights similarities, rather than differences, of rural small and medium enterprises (SMEs) in developing countries and comparative Northern European locations. The key role of social capital, cultural values and norms is analysed and comment presented on small island experiences. Arguments are made for policies to be proofed for locational differences and for further research to understand the opportunities offered by islands and coastal communities in a world where the particularities of place and space are increasingly valued, and aspects of remoteness can be rearticulated to good effect.
Losing It: Politics of the Other (Medium)
Authors: Bal Mieke
Published: January 2017

Finnish cinematographer Eija-Liisa Ahtila makes video installations of a particularly griping intensity, staging a contact zone for encounters with otherness. They also deploy other media, such as literature, and other genres, such as documentary, along with other states of being, such as murder, maidenhood, and madness. This multiple otherness, I argue here, is crucial for the understanding of the way this artist uses a medium that is ostensibly visual to make environments that are political through encompassing engagements with otherness as other media.

In the reception of her work, this heterogeneity is largely ignored in favour of interpretations of the installations anchored in a single medium – video installation – and a political individualism. This is most clear in the reception of The House, Ahtila’s best-known work. This is consistently interpreted as a representation of schizophrenia. That such negligence of a sophisticated heterogeneity has political consequences becomes obvious once we see that the ‘madness’ of the character in that piece is the symptom of her alterity, and is staged through a discrepancy between image and sound – the schizophrenia of the medium.

In this essay I briefly revisit three of Ahtila’s best-known pieces in relation to an ‘other’ discourse: literature, psychoanalysis, and philosophy. In each, both the other media and the otherness of people take very different forms. In each case, though, the alterities of medium and subject matter coincide to reinforce the point that is basic to all of Ahtila’s work: the encounter with otherness on a non-exclusionary basis, as, also, an encounter with the otherness without ourselves. In the last section I also bring in two works by other artists, to make a case for a political potential inherent in the art form of video installation.
Modified Technique for Recovering Aortoiliac Homografts
Authors: Tamazashvili Tamaz , Yushkov Yuriy Y. , Roca Michael
Published: January 2017

Background

Infection of the prosthetic aortic graft bypass remains one of the most serious complications of aortoiliac bypass grafts. Use of an aortoiliac allograft as a replacement for an infected prosthetic graft is an effective treatment for this problem. However, the availability of aortoiliac grafts is affected by the high rate of procurement errors experienced during recovery. This overall error rate nationally averaged 32.5% in 2006, of which nearly a third (9.6%) were related to tears of the intima at or below the bifurcation of the abdominal aorta.

Objective

To analyze the potential of a new aortoiliac graft recovery method in reducing the error rate.

Method

A modified technique of aortoiliac graft recovery was used to minimize the possibility of intimal tears. The essence of this technique is to change the sequence of mobilization of the graft, starting from the zone of low resistance, which is at the iliac arteries, and continuing upward to the abdominal aorta, which has higher resistance because of the greater thickness of the aortic wall. An additional modification of the standard technique is to use a tourniquet to raise the aortic edges.

Conclusion

The aortoiliac graft has various resistances to tearing owing to the different wall thicknesses of the aorta and the iliac arteries. Mobilization of the abdominal aorta before dissection of the iliac arteries creates a high risk of tears at and around the bifurcation of the aorta and the iliac arteries.
Comparative Analysis of Clinical Efficacy and Cost between University of Wisconsin Solution and Histidine-Tryptophan-Ketoglutarate
Authors: Bellamy Chris A. , Nicely Bruce , Mattice Burton J. , Teaster Rob
Published: January 2017

Objective

To compare University of Wisconsin solution (Viaspan), the universal standard for organ preservation, with histidine-tryptophan-ketoglutarate solution. An analysis of each solution, in reference to clinical trials with specific organs, is presented and assessed to find the efficacy of each in a clinical environment. Also to view each solution from an economical standpoint, and in the end develop an overall understanding of the key similarities and differences between each solution in order to assess appropriate use of each in a clinical setting.

Data Sources

A literature search was conducted by using PubMed, MEDLINE, BIOSIS, Embase, and other online data bases to find the most recent studies of University of Wisconsin and histidine-tryptophan-ketoglutarate solutions. Search terms included University of Wisconsin solution, histidine-tryptophan-ketoglutarate, preservation solution, cost analysis, biliary complication, and other related subjects.

Study Selection

Previous research was selected from the literature search to provide basic information on the 2 solutions and also to provide clinical examples of each solution and the efficacy of each with specific organs.

Data Synthesis

Information and published articles on the 2 solutions were gathered for descriptive and comparative purposes.

Conclusions

The 2 solutions appear equally effective in organ preservation. Each solution has its own organ-specific qualities, and each has different complications. The studies reviewed here indicate that the differences are minor and thus suggest that the 2 solutions are equally acceptable for clinical use. Of the 2 solutions, histidine-tryptophan-ketoglutarate costs less than University of Wisconsin solution.
Roller Coaster Marathon: Being a Live Liver Donor
Authors: Cabello Charlotte C. , Smolowitz Janice
Published: January 2017

The purpose of this phenomenological study was to examine the meaning of being a live liver donor. Six people between ages 27 and 53 years participated. A qualitative, in-depth, semistructured interview format was used to explore donors' thoughts and feelings about being an organ donor. Five themes were identified: (1) no turning back—how do I live without you? (2) roller coaster marathon, (3) donor network, (4) the scar, and (5) reflections—time to think. At the center of the experience was the donor's commitment to the recipient. Once donors began the process, they were determined to see it through. The process was complex, and donors received various levels of support from family, friends, health care professionals, and others. After donation, as donors recovered and were able to resume their usual daily responsibilities, they reflected on the impact of the experience and how it changed their view of life.
Prevalence and Correlates of Influenza Vaccination among Kidney Transplant Patients
Authors: Berben Lut , Denhaerynck Kris , Schaub Stefan , De Geest Sabina
Published: January 2017

Context

Immunosuppressive regimens increase kidney transplant patients' risk of contracting life-threatening influenza. However, little information exists about the prevalence and correlates of influenza vaccinations in this population.

Objective

To determine the prevalence and explore correlates of influenza vaccination in kidney transplant recipients.

Design, Sample, and Setting

This cross-sectional study used data from the Supporting Medication Adherence in Renal Transplantation study. The convenience sample consisted of 356 adult kidney transplant recipients (58.1% male; mean age, 52.9 [SD 13.53] years) recruited from 2 Swiss transplant outpatient clinics. Influenza vaccination status was assessed by self-report (yes/no).

Main Outcome Measure

Known correlates of vaccination in chronically ill patients (older age, cohabitation, higher education, higher socioeconomic status, financial stability, more comorbid diseases, nonsmoking status, and clinical site where care is received) were entered into a multiple logistic regression model.

Results

Of the 356 patients, only 83 (23.3%) reported having been vaccinated against influenza in the previous year. Positive vaccination status was significantly related to older age (odds ratio, 1.04; 95% confidence interval, 1.02–1.06).

Conclusion

Despite national and international guidelines recommending influenza vaccination in kidney transplant recipients, the prevalence of influenza vaccination in this sample was low. This study's results suggest that transplant centers need to implement policies to maximize influenza vaccination of their patients.
Attitude of Nursing Staff toward Organ Donation in a Spanish Hospital with a Solid-Organ Transplant Program
Authors: Zambudio Antonio Ríos , Martínez-Alarcón Laura , Parrilla Pascual , Ramírez Pablo
Published: January 2017

Context

Nursing personnel are fundamental in the organ donation and transplantation process, and their attitude toward donation has a decisive effect on patients, patients' families, and the general public.

Objective

To analyze the attitudes of nursing personnel toward donation in a transplant hospital and the factors that determine those attitudes.

Materials and Methods

A random sample of 305 nurses in different hospital services was taken and stratified by type of service. A validated psychosocial questionnaire was used to evaluate attitudes toward donation. The survey was completed anonymously and was self-administered. Student t test, χ2 test, and logistic regression analysis were used for statistical analysis.

Results

Most respondents (63%) favored organ donation. The following variables affected attitude: (1) having a favorable attitude toward donation of a family member's organs ( P < .001), (2) knowing the concept of brain death ( P < .001), (3) having discussed organ donation and transplantation within the family ( P = .001), (4) having a favorable attitude toward autopsy ( P = .006), (5) fearing mutilation of the body ( P < .001), (6) a partner's attitude toward organ donation and transplantation ( P < .001), and (7) the respondent's religion ( P = .009). Multivariate analysis yielded the following significant factors: (1) fear of mutilation of the body (odds ratio, 9.5), (2) partner's attitude toward organ donation and transplantation (odds ratio, 0.2), and (3) respondent's religion (odds ratio, 2.7).

Conclusions

Attitudes toward organ donation among nurses are similar to attitudes of the general public in Spain. Given the influence of nurses on the general public, promotional campaigns directed at nurses are a priority.
Impact on peel strength, tensile strength and shear viscosity of the addition of functionalized low density polyethylene to a thermoplastic polyurethane sheet calendered on a polyester fabric
Authors: Jacquot Pierre-Baptiste , Perrin Didier , Léger Romain , Gallard Benjamin , Ienny Patrick
Published: January 2017

Coated technical textiles are widely used for several industrial applications. Most of these coated fabrics are made with a polyester fabric and a polyvinyl chloride (PVC) coating but in order to reduce the environmental impact, the producers are willing to substitute PVC by thermoplastic polyurethane (TPU). However, a technological lock of the calendering of TPU on polyester fabric is the ability to get a good adhesion of the coating on the fabric. Producers could increase the temperatures of extrusion of the coating but TPU have a short range of extrusion temperatures making it difficult to extrude. One solution is to make a blend with another polymer which has a higher extrusion temperature range. In the present work, the studies of the addition of low density polyethylene (LDPE) and linear low density polyethylene grafted maleic anhydride (LLDPE-g-Ma) in polyurethane coating on the tensile strength of the sheet and on the peel strength with a polyester fabric have been studied as well as the influence of the extrusion temperature. SEM observations, FTIR spectrums, and viscosity measurements have been performed to understand the behavior of the different blends. Results show that extrusion temperature and penetration depth of the coating in the fabric have a positive influence on the peel strength.
Preclinical Evaluation of 18F-ML-10 to Determine Timing of Apoptotic Response to Chemotherapy in Solid Tumors
Authors: Demirci Emre , Ahmed Rafay , Ocak Meltem , Latoche Joseph , Radelet April , DeBlasio Nicole , Mason N. Scott , Anderson Carolyn J. , Mountz James M.
Published: January 2017

Purpose:

We investigated 2-(5-fluoro-pentyl)-2-methyl-malonic acid (18F-ML-10) positron emission tomography (PET) imaging of apoptosis posttherapy to determine optimal timing for predicting chemotherapy response in a mouse head/neck xenograft cancer model.

Procedures:

BALB/c nude mice (4-8 weeks old) were implanted with UM-SCC-22B tumors. The treatment group received 2 doses of doxorubicin (10 mg/kg, days 0, 2). Small animal 18F-ML-10 PET/computed tomography was performed before and on days 1, 3, and 7 postchemotherapy. Using regions of interest around tumors, 18F-ML-10 uptake change was measured as %ID/g and uptake relative to liver. Terminal Uridine Nick-End Labeling (TUNEL) immunohistochemistry assay was performed using tumor samples of baseline and on days 1, 3, and 7 posttreatment.

Results:

Treated mice demonstrated increased 18F-ML-10 uptake compared to baseline and controls, and 10 of 13 mice showed tumor volume decreases. All control mice showed tumor volume increases. Tumor-to-liver (T/L) ratios from the control group mice did not show significant change from baseline ( P > .05); however, T/L ratios of the treatment group showed significant 18F-ML-10 uptake differences from baseline compared to days 3 and 7 posttreatment ( P < .05), but no significant difference at 1 day posttreatment.

Conclusion:

2-(5-Fluoro-pentyl)-2-methyl-malonic acid PET imaging has the potential for early assessment of treatment-induced apoptosis. Timing and image analysis strategies may require optimization, depending on the type of tumor and cancer treatment.
The Principle of Digital Subtraction Angiography and Radiological Protection
Authors: Okamoto K. , Ito J. , Sakai K. , Yoshimura S.
Published: January 2017

Recent improvements in x-ray technology have greatly contributed to the advancement of diagnostic imaging. Fluoroscopically guided neurointerventional procedures with digital subtraction angiography (DSA) are being performed with increasing frequency as the treatment of choice for a variety of neurovascular diseases. Radiation-induced skin injuries can occur after extended fluoroscopic exposure times, and the injuries have recently been reported. In this article, measured radiation doses at the surface of Rando Phantom with Skin Dose Monitor, and estimated and measured entrance skin doses in patients underwent neurointerventional procedures are reported as well as means of reducing radiation doses absorbed by patients and personnel to avoid occurrence of radiation-induced injuries.
Significance of Volume Embolization Ratio as a Predictor of Recanalization on Endovascular Treatment of Cerebral Aneurysms with Guglielmi Detachable Coils
Authors: Uchiyama N. , Kida S. , Nomura M. , Hasegawa M. , Yamashima T. , Yamashita J. , Matsui O.
Published: January 2017

The purposes of this study are, firstly, to define the relationship between volume embolization ratio (VER) and degree of angiographical occlusion in endovascular treatment with Guglielmi detachable coils, and secondly, to examine influences of neck and dome sizes of aneurysms on the VER and the angiographical treatment result, and thirdly, to determine the relationship between the VER and the recanalization of coiled aneurysms.

Fifty-two aneurysms in 46 patients were examined. VER ranged 8.1–31.9% (mean 18.5%). The mean VERs of each categories based on angiographical treatment results were 23.1% in complete occlusion, 16.1% in neck remnant and 12.2% in incomplete occlusion, respectively. The VER correlated significantly with both neck and dome size, while the angiographical treatment result was only affected by neck size. Five aneurysms showed aneurysmal recanalization among followed-up 41 aneurysms. All recanalized aneurysms were large, and their VERs were in range of 10.4–17.6%.

Measurement of VER is useful to estimate the degree of occlusion objectively and to predict the aneurysmal recanalization. A small aneurysms with a small neck is relatively easy to achieve high VER and angiographical complete occlusion, with the consequence of less recanalization. On the other hand, a large aneurysm is liable to recanalize due to low VER, even if there was little filling of contrast medium in the aneurysmal cavity.
Endovascular Treatment with GDC for Severe Acute SAH: Comparison with Early Direct Surgery
Authors: Kobayashi S. , Satoh A. , Koguchi Y. , Yamauchi T. , Itoh S. , Ooishi H. , Nakamura H. , Yagishita T. , Watanabe Y.
Published: January 2017

The purpose of this study was to evaluate the effect of endovascular treatment with Guglielmi detachable coils (GDC) on the outcome of severe subarachnoid hemorrhage (SAH) caused by acute rupture of a cerebral aneurysm and on the incidence of symptomatic vasospasm. Thirty-five patients with aneurysmal SAH were treated in the acute stage using GDC. Fifteen out of 17 patients in Hunt & Kosnik grades I, II, and III showed good recovery (GR) at discharge, while one was moderately disabled (MD) and one was severely disabled (SD). Among 16 patients in poor neurological condition (GCS was ⩽ 9 on admission), the outcome was GR in 5 cases (31%), MD in 2 (13%), and SD in 9 (56%). These results were better than those for surgically treated patients with the same neurological status. The difference in outcome between endovascular treatment and surgery may have been related to the difference in the insult to the brain caused by each modality.

The incidence of symptomatic vasospasm was lower in the GDC group (5.7%) than in the surgical group (12%). In the patients treated with GDC and intrathecal administration of urokinase, subarachnoid clots were cleared more rapidly than in those treated surgically with continuous cisternal irrigation. The accelerated clearance of subarachnoid clots in the GDC group might have helped to prevent delayed vasospasm.

The long-term efficacy of GDC embolization in preventing subsequent bleeding has not yet been determined. However, this method seems to be less traumatic for the brain and may be suitable for treatment of patients with severe SAH.
Coil Migration, Malposition, Stretching and Retrieval
Authors: Abe T. , Hirohata M. , Tanaka N. , Uchiyama Y. , Morimitsu H. , Kojima K. , Hayabuchi N.
Published: January 2017

In this educational program for complicated coil placements, we report several cases of coil malposition, migration, and retrieval. We emphasize that a decrease in the expected one-to-one motion of the coil is the earliest sign of a possible imminent complication, and the over the core wire technique with a fixed-loop snare (Gooseneck microsnare) is a very effective potential solution for elongated coil retrieval.
Basilar Artery Percutaneous Transluminal Angioplasty
Authors: Sheikh B.Y. , Ezura M. , Takahashi A. , Yoshimoto T.
Published: January 2017

This is a retrospective study of 15 cases with symptomatic basilar artery atherosclerotic chronic stenosis. One patient presented with reversible ischemic neurological deficits and another with completed infarction, the rest of patients presented with progressive transient neurological deficits (TIA) that was refractory to medical treatment. The protocol of PTA included the use of single lumen balloon catheter (Stealth; Boston Scientific, Boston, MT) and the pre-balloon inflation injection of Urokinase (UK). All lesions were successfully dilated except for one. Those with uncomplicated successful dilatation had good control of their neurological status with disappearance of the pre-PTA TIA. The authors conclude that PTA for basilar artery atherosclerotic lesions is possible and a promising procedure when the patients are carefully selected and the operation is performed by a team with good experience in such lesions.
A New Stent Graft
Authors: Nishi S. , Nakayama Y. , Ueda H. , Ishikawa M. , Matsuda T.
Published: January 2017

The use of stents improves the result after balloon coronary angioplasty. Restenosis due to neointimal hyperplasia and proliferation of smooth muscle cells are, however, a concern. In the present report, we studied the prevention of restenosis to allow endothelial cell migration and growth to proceed through micropores using our developed stent graft with micropored segmented polyurethane (SPU) thin film in a normal beagle model.

Our developed stent graft was made from Palmaz stent and micropored SPU thin film. The SPU film was arranged into four different micropore densities around the circumference: no micropores, arrangement 4; micropores of 30μm in diameter with an orderly distance of 250μm; (arrangement 1), 500μm; (arrangement 2) and 125μm (arrangement 3) between the neighboring two pores. Micropores were made using the Excimer laser ablation technique. The Palmaz stent was wrapped with micropored film, sutured, and glued with DMF (dimethyl formamide) under aid of a microscope. These stents were placed in the common carotid arteries of beagles (n = 5). They were sacrificed at 1 month, and a histological study and scanning electron microscopy study were performed for evaluation of endoluminal endothelialization.

In 10 arteries applied with stent grafts, there was no severe stenosis although it did occur to some extent. All stented arteries were patent. Endothelial cell migration and growth through micropores were observed histologically on micropored SPU thin film in this model, which did not affect the intraluminal diameter. In most non-porous regions, significant thrombi were found between the SPU film and the neointimal layer. On the other hand, in the porous region, little thrombosis was observed except in the lowest density region. In 125μm of distance between two neighboring pores, the neointimal layer was the thinnest, which was suitable for wide intraluminal space after placement of a stent graft.

Endothelial cell migration and growth through micropores were confirmed in the animal model using our developed micropored stent graft. The proceeding of their migration was controlled by micropore density under a constant micropore diameter. The stent graft with micropored SPU thin film is promising for the prevention of restenosis due to neointimal hyperplasia.
Embolization of Arteriovenous Malformation with Diluted Mixture of NBCA
Authors: Tamatani S. , Koike T. , Ito Y. , Tanaka R.
Published: January 2017

The technique of nidus embolization with N-butyl-2-cyanoacrylate (NBCA) glue is presented. The microcatheter is navigated into the nidus and the tip is set in a wedged position. A diluted mixture of NBCA in ethiodized oil (a 25% mixture is mainly used) is injected very slowly, using complete column technique. Using this technique, the progression of glues in the nidus can be seen easily, which leads to improve accuracy and effectiveness of embolization. The mean blood pressure is maintained 15% to 20% below baseline for several days after the embolization to prevent hemorrhage caused by normal pressure breakthrough. We believe this technique is very useful and effective method for the treatment of arteriovenous malformations. However, considerable experience in this technique should be required.
Vascular Anatomy of the Spinal Cord and Classification of Spinal Arteriovenous Malformations
Authors: Miyasaka K. , Asano T. , Ushikoshi S. , Hida K. , Koyanagi I.
Published: January 2017

The arterial and venous anatomy of the spinal cord was described in terms of extrinsic and intrinsic contribution to the cord substance. Based upon anatomical location of an arteriovenous shunt, spinal arteriovenous malformations (AVMs) were classified into intramedullary AVM, perimedullary arteriovenous fistula (AVF) and dural AVF. This simple classification seems practical from the standpoint of endovascular and surgical treatments since it reflects anatomical differences in the shunt location, which is the target in either approach.
Reversibility of Ischemia Evaluated by Ischemic Duration and Residual Cerebral Blood Flow
Authors: Nakano S. , Iseda T. , Goya T. , Wakisaka S.
Published: January 2017

We first investigated the time course of CBF thresholds of ischemic cortices by a retrospective review of 19 patients with MCA occlusion who had clearly defined ischemic duration from onset to angiographic complete recanalization. Secondly, CBF thresholds of ischemic cortices salvageable with intravenous low dose native t-PA infusion therapy (7.2 mg of tisokinase) were examined by a retrospective review of 20 patients with distal embolic occlusions of MCA divisions or branches. All patients underwent pretreatment CBF measurement by SPECT using 99mTc-ECD. Pretreatment SPECT and 3 months post-treatment CT images were compared using computerized coregistration. The degree of hypoperfusion was analyzed by an asymmetry index (AI), which was a count-density ratio for the ischemic lesion to the contralateral corresponding area. Ischemic cortices on SPECT were divided into reversible and irreversible lesions.

Judging from the regression lines with 95% confidence interval between the ischemic duration and AI, the infarcted CBF thresholds at 3 and 6 hours after onset may be about 30 and 50% of contralateral presumed normal CBF, respectively.

On the other hand, to save the ischemic tissue with our intravenous t-PA infusion therapy, residual CBF might be needed at least 45% of contralateral presumed normal CBF. It is likely that CBF threshold of ischemia surely salvageable with our intravenous t-PA infusion therapy may be approximately 50–55% of contralateral presumed normal CBF.
Local Fibrinolysis for Middle Cerebral Artery Embolism Criteria for the Indication by Evaluation of Residual Cerebral Blood Flow and the Results
Authors: Hyogo T. , Kataoka T. , Hayase K. , Nakagawara J. , Takeda R. , Nakamura H.
Published: January 2017

We summarize our clinical experience of the local fibrinolysis for the middle cerebral artery (MCA) embolism. We added residual CBF factors of the ischemic territories to the usual criteria for the indication of fibrinolysis by Xe-SPECT CBF measurement. Forty-nine cases of local fibrinolysis for MCA embolism were reviewed and the results were compared with the conservative medical treatment cases.

Angiographical improvements were achieved in 38 cases (76%, full reopening 17/49, partial reopening 21/49) and favorable outcomes (good recovery at GOS) were obtained in 32 cases (65%) at three months follow-up outcome. In comparison with the conservative medical treatment, fibrinolysis was superior at good recovery rate, severe disability rate and the resulted large infarction rate with statistical significance.

We concluded that the local fibrinolysis with evaluation of the residual CBF of the ischemic territories achieved good results and outcomes and superior to the conservative medical treatment at some points. To keep the therapeutic time window, it is necessary to include the CBF factor to the criteria for the indication of this treatment.
Critical Pathway and Hospital-Hospital Cooperation in Acute Stroke Reduction of the Length of Hospital Stay
Authors: Hashimoto Y. , Terasaki T. , Yonehara T. , Tokunaga M. , Hirano T. , Uchino M.
Published: January 2017

Stroke patients tend to stay longer in one hospital compared to patients with other neurological disease.

After the introduction of 3 types of critical pathway dedicated for various severity of acute ischemic stroke in 1995, the average length of in-hospital days declined from 30.0 days (1993) to 15.3 days (1998), ie 49% reduction.

This reduction was achieved by the use of critical pathway and the hospital-hospital cooperation.
Technical Note on VDS
Authors: Henkes H. , Drepper P. , Speder J. , Felber S. , Monstadt H. , Kühne D.
Published: January 2017

A new system was deviced that allows the electrolytical detachment of platinum microcoils at variable lengths for the endovascular treatment of intracranial aneurysms.

The detachment element consists of two short platinum coil segments, which are connected by a threat of stainless steel. The steel threat is interrupted by electrolysis, using a continuous current with 1–2 mA at a voltage of 4–8 Volt. The average detachment time in heparinized blood is about 30–40 sec. The detachment elements can be used to connect either an insertion wire with a platinum coil or to connect several segments of platinum coils with variable helices and lengths. If several detachment elements are integrated in a coil, electrolysis interrupts only the element, which is next beyond the distal tip of the catheter.

The electrolytical process does not affect the detachment elements proximal and distal to the element adjacent to the tip of the catheter. Single or several coil segments can be pulled back into the microcatheter if necessary. The system is expected to allow a faster and more complete endovascular coil occlusion of intracranial aneurysms. The principles described in this paper are claimed by the German pending patent DE 100 10840 A1.
The Usefulness of External Marking in Stenting for M1 Segment of Middle Cerebral Artery Stenosis
Authors: Shin Y.S. , Kim S.Y. , Yoon S.H. , Cho K.H. , Ahn Y.H. , Cho K.G.
Published: January 2017

In intracranial stenting procedures, especially for a focal stenosis on the M1 portion of the middle cerebral artery, the anatomical configuration of the middle cerebral artery is changed with the advance of a rigid stent catheter. Therefore, the location of the stenotic portion where the stent is supposed to be deployed, according to pre-measurements on the roadmapping image, could be changed to some degrees. To prevent this error, we put a 30 gauge needle with cap at the orbital rim on the same preliminary vertical line of the distal end of the stenotic portion where the distal end of the stent is supposed to be deployed and the stent deployment is performed under guidance of the external marking on the fluoroscopic image not under roadmapping image. We report our experience of successful elective stenting of middle cerebral artery stenosis using the aid of external marking.
A Randomized Trial on the Safety and Efficacy of Endovascular Treatment of Unruptured Intracranial Aneurysms is Feasible
Authors: Raymond J. , Chagnon M. , Collet J-P , Guilbert F. , Weill A. , Roy D.
Published: January 2017

The safety and efficacy of endovascular treatment of unruptured intracranial aneurysms remain undetermined. A randomized trial may be the best way to demonstrate the potential benefits of endovascular management.

We propose a randomized, prospective, controlled trial comparing the incidence of subarachnoid haemorrage of patients treated by endovascular coiling as compared to conservative management. We would also study a composite outcome combining SAH and the morbidity of treatment. All patients with one or more unruptured aneurysm >> 3 mm eligible for endovascular treatment would be proposed to participate. The study would be conducted in 40–50 centres. The entire study would enrol 1800 patients, recruited over three years and followed for five years, but would be preceded by a feasibility study on 200 patients.

A randomized trial comparing endovascular and conservative treatment could have an important impact on the clinical management of intracranial aneurysms
Spontaneous Petrous Carotid Artery Occlusive Dissection Treated by Local Fibrinolysis and Stent Deployment
Authors: Villa G. , Cellerini M. , Mangiafico S. , Ammannati F. , Giordano G. P.
Published: January 2017

This paper reports a case of local thrombolytic therapy followed by stenting of the petrous carotid in a young woman with recurrent transient ischemic attacks from spontaneous dissection. A total of four overlapping balloon-expandable stents were delivered in two different sessions one month apart.

The procedure resulted in a potentially efficacious treatment for the prevention or reduction of cerebral damages from ischemia. At follow-up three months later the patient was symptom free and DSA revealed a delayed proximal small pseudoaneurysm and a carotid-cavernous fistula. At one year follow-up the patient was still symptom-free with unmodified findings at cerebral angiography.
Embolization of Cerebral Aneurysms with Spherically Shaped Detachable Microcoils (MicruSphere Microcoil System)
Authors: Lee D.H. , Arat A. , Morsi H. , Jou L-D. , Mawad M.E.
Published: January 2017

We present our initial experience of concentric-filling technique using MicruSphere 3D coils (Micrus Endovascular, San Jose, CA) in the treatment of intracranial aneurysms.

149 intracranial saccular aneurysms in 142 consecutive patients (mean age 56.6 ± 12.7, ruptured in 54 (36.2%)) were treated with the concentric-filling technique. The mean aneurysm volume was 169.0 ± 363.0 mm3. Neck remodeling technique was used in 120 (80.5%). Procedure-related problems were recorded. Initial embolization results were evaluated, and the coil packing density was calculated. Clinical and angiographic follow-ups were performed after six months. Any changes in embolization status were classified as ‘improved’, ‘unchanged’, or ‘worse’.

The overall packing density was 40.1% (range 10.5–90.9%). The permanent morbidity and mortality rates were 4.0% and 1.3%, respectively. The initial Raymond and Roy classification results were class 1 in 37 aneurysms (24.8%), class 2 in 50 (33.6%), and class 3 in 62 (41.6%). On the mean follow-up examination of 8.2 months in 103 patients (72.5%), there were one transient ischemic attack, one minor stroke, and one instance of rebleeding. Angiographic follow-up in 101 aneurysms (67.8%) showed the change in embolization status as ‘improved’ in 42 aneurysms (41.6%), ‘unchanged’ in 42 (41.6%), and ‘worse’ in 17 (recanalisation rate, 16.8%).

The concentric-filling technique using Micrusphere 3D coils was effective in achieving high packing density which in turn resulted in stable embolization in the majority of the aneurysms. Longer follow-up is warranted to determine the durability of these results.
Two Cases of a Dural Arteriovenous Fistula Mimicking a Brain Tumor
Authors: Ishihara H. , Ishihara S. , Okawara M. , Suzuki M. , Kanazawa R. , Kohyama S. , Yamane F. , Uchino A.
Published: January 2017

Dural arteriovenous fistula (d-AVF) is relatively rare. Some cases of atypical locations are often difficult to distinguish from other vascular disorders or tumors because those d-AVFs show various onsets, such as subcortical bleeding and venous infarctions. We encountered two cases of d-AVF with severe brain edema that took adequate time to distinguish from brain tumors. A 68-year-old man visited his local physician complaining of dizziness. He was diagnosed with a cerebral infarction due to the presence of an abnormal cerebellar signal on magnetic resonance imaging (MRI) and was treated by drip infusion. However, he did not recover and was admitted to our hospital with suspicion of a brain tumor. A 75-year-old woman with an onset of progressive dementia and gait disturbance showed severe edema of the right-front temporal lobe on MRI. Both these cases were examined by single photon emission computed tomography or positron emission tomography and were scheduled for craniotomy and biopsy based on the diagnosis of brain tumor. We performed pre-operative angiography and found d-AVFs. We embolized the d-AVFs with liquid material and both patients recovered well.

Brain edema from d-AVF or a tumor can be distinguished by carefully reading the MRI with findings such as the distribution of the edemas, differences on diffusion-weighted images, and contrast-enhanced images. Therefore, it is important to provide initial accurate diagnoses to prevent patient mistrust and irreversible disease conditions.
Vertebrobasilar Dissection with Pseudo-Aneurysm or Subarachnoid Hemorrhage: Intracranial Stenting as the Only Treatment
Authors: Helyar V. , Söderman M. , Andersson T. , Holmin S.
Published: January 2017

Vertebrobasilar dissection may cause ischaemia or subarachnoid haemorrhage and can pose a significant treatment challenge. Endovascular treatment using stents alone has been described but there are few reports of its clinical application. We here report our experiences from three cases of vertebrobasilar dissection and pseudo-aneurysm or subarachnoid hemorrhage treated with stents alone.
Osteogenesis Imperfecta, Multiple Intra-Abdominal Arterial Dissections and a Ruptured Dissecting-Type Intracranial Aneurysm
Authors: Matouk C.C. , Hanbidge A , Mandell D.M. , Terbrugge K.G. , Agid R.
Published: January 2017

We describe an adult patient with a ruptured dissecting-type superior cerebellar artery aneurysm and known osteogenesis imperfecta. He was successfully treated with coil embolization and intentional parent vessel sacrifice. During his hospital admission, he also suffered from abdominal distension. An incidental note was made of multiple intra-abdominal arterial dissections. These were managed conservatively. We review the rare association of osteogenesis imperfecta and intracranial aneurysms, as well as discuss management implications.
Subcutaneous Hematoma Associated with Manual Cervical Massage during Carotid Artery Stenting
Authors: Tsurumi A. , Tsurumi Y. , Negoro M. , Yokoyama K. , Oheda M. , Susaki N. , Tsugane S. , Takahashi T. , Miyachi S.
Published: January 2017

We describe a patient with subcutaneous hematoma associated with manual cervical massage during carotid artery stenting.

A 73-year-old man with left cervical carotid artery stenosis presented with left amaurosis fugax. We performed carotid artery stenting using distal embolic protection with balloon occlusion. Dual antiplatelet therapy was maintained in the periprocedural period and an anticoagulant agent was administered during the procedure. Because the aspiration catheter became entrapped by the stent, it did not reach the distal side of the stenotic lesion, and manual compression of the cervical region was therefore performed. Immediately afterwards, a subcutaneous hemorrhage occurred in the cervical region. There was no postoperative dyspnea due to enlargement of the hematoma, which was absorbed spontaneously.

Cervical subcutaneous hematoma can occur in the cervical region due to cervical massage in patients who are receiving adjuvant antiplatelet therapy and anticoagulation therapy.
Spontaneous Isolated Dural Arteriovenous Fistula of the Cavernous Sinus: Endovascular Approach via the Foramen Ovale
Authors: de Andrade G. Cabral , Alves H.P. , Parente R. , Salvarani C.P. , Clímaco V.M. , Pereira E.R.
Published: January 2017

The endovascular treatment of spontaneous dural cavernous sinus fistula (DAVF) can be accomplished by arterial approach, just with symptoms relief, or by numerous venous approaches through the inferior petrosal sinus, ophthalmic vein, anterior or posterior intercavernous sinus and facial vein. Our case suggests the approach to the cavernous sinus via the foramen ovale and emissary veins puncture as an alternative when there is no possibility of venous approach conventionally described.

A 76-year-old woman presented with right conjunctival hyperemia, exophthalmos, intraocular pressure increasing and visual deficits in a period of six months. Angiographic diagnosis of spontaneous DAVF isolated from the cavernous sinus, Barrow Type C, with exclusive venous drainage through the superior ophthalmic vein. Endovascular treatment was performed under general anesthesia. Attempts to approach the cavernous sinus through the inferior petrosal sinus ipsilateral and contralateral intercavernous, facial vein and pterygoid plexus, as well as by dissection and direct puncture of the superior ophthalmic vein were not possible. An approach to the cavernous sinus was performed by puncturing the foramen ovale, catheterization of the emissary vein of the foramen ovale with occlusion of the fistula with microcoils. There was a symptomatic regression with gradual normalization of intraocular pressure, exophthalmos and conjunctival hyperemia in three months.

The approach to the cavernous sinus through the foramen ovale and catheterization of the emissary cranial skull base vein is an exception and should be considered in cases of spontaneous and isolated DAVF not accessible by a conventional approach.
Intracranial Vertebral Artery Dissections: Evolving Perspectives
Authors: Ali M.S. , Amenta P.S. , Starke R.M. , Jabbour P.M. , Gonzalez L.F. , Tjoumakaris S.I. , Flanders A.E. , Rosenwasser R.H. , Dumont A.S.
Published: January 2017

Intracranial vertebral artery dissection (VAD) represents the underlying etiology in a significant percentage of posterior circulation ischemic strokes and subarachnoid hemorrhages. These lesions are particularly challenging in their diagnosis, management, and in the prediction of long-term outcome. Advances in the understanding of underlying processes leading to dissection, as well as the evolution of modern imaging techniques are discussed. The data pertaining to medical management of intracranial VADs, with emphasis on anticoagulants and antiplatelet agents, is reviewed. Surgical intervention is discussed, including, the selection of operative candidates, open and endovascular procedures, and potential complications. The evolution of endovascular technology and techniques is highlighted.
Structural Analysis for Wingspan Stent in a Perforator Model
Authors: Fujimoto Motoaki , Shobayashi Yasuhiro , Takemoto Koichiro , Tateshima Satoshi , Viñuela Fernando
Published: January 2017

Perforator infarction represents a critical problem after intracranial Wingspan stent. To explore the mechanism of perforator infarction, we simulated the stent-artery interaction at an atheromatous plaque with perforator. Structural deformation and biomechanical stress distribution after stenting were analyzed. High radial stress values were located along the stent struts, which surrounded the area with high circumferential stress. Stretched perforator orifice in a circumferential direction after stenting was simulated. These results show that structural deformation could play a role in the mechanism of perforator occlusion after Wingspan stenting.
Safety and Feasibility of a Novel Vascular Closure Device in Neurointerventional Procedures
Authors: Taha Ammar , Walsh Ellen K , Wright Kathryn A , Ahmed Iftikhar , Supakul Nucharin , Awwad Eric E , Tejada Juan G.
Published: January 2017

This retrospective study evaluated the safety and feasibility of a new arterial femoral access closure device in neurointerventional procedures.

The study includes all consecutive adult patients who underwent femoral arteriotomy closure with the MynxGrip™ closure device after Neurointerventional procedures performed between June and December 2012. All patients had a follow-up color Doppler ultrasound (US) within 48 hours after the procedure, which was independently interpreted by two experienced radiologists to evaluate for access site complications. Device success/failure, sheath size, ambulation time, and periprocedural complications were recorded.

Fifty-five closure devices were deployed in 53 patients. There were 23 (43%) males and 30 (57%) females; age ranged from 22 to 84 years (mean: 52.1 years). Thirty of the 55 procedures (55%) were therapeutic and 25 were diagnostic interventions (45%). Sheath sizes used were 5F in 35 procedures (64%) and 6F in 20 procedures (36%). The right femoral artery was accessed in 51 procedures (93%) and the left in four procedures (7%). There was only one (1.8%) minor periprocedural complication (small hematoma). Hemostasis was successful in 51 of the 55 procedures (93%) with subsequent early ambulation. No device-induced complications associated with serious clinical sequelae were reported.

In our small series, the MynxGrip™ femoral access closure device provided a safe and feasible way of closing the femoral artery puncture site after neurointerventional procedures with low minor complication rates and no major complications. Further large prospective randomized trials are necessary to evaluate the efficacy of the device.