bluuebunny/crossref_metadata_2025 huggingface dataset:
Nocturnal oxygen saturation profiles of healthy term infants
Authors: Terrill Philip Ian , Dakin Carolyn , Hughes Ian , Yuill Maggie , Parsley Chloe
Published: July 2014

Objective

Pulse oximetry is used extensively in hospital and home settings to measure arterial oxygen saturation (SpO2). Interpretation of the trend and range of SpO2values observed in infants is currently limited by a lack of reference ranges using current devices, and may be augmented by development of cumulative frequency (CF) reference-curves. This study aims to provide reference oxygen saturation values from a prospective longitudinal cohort of healthy infants.

Design

Prospective longitudinal cohort study.

Setting

Sleep-laboratory.

Patients

34 healthy term infants were enrolled, and studied at 2 weeks, 3, 6, 12 and 24 months of age (N=30, 25, 27, 26, 20, respectively).

Interventions

Full overnight polysomnography, including 2 s averaging pulse oximetry (Masimo Radical).

Main outcome measurements

Summary SpO2statistics (mean, median, 5th and 10th percentiles) and SpO2CF plots were calculated for each recording. CF reference-curves were then generated for each study age. Analyses were repeated with sleep-state stratifications and inclusion of manual artefact removal.

Results

Median nocturnal SpO2values ranged between 98% and 99% over the first 2 years of life and the CF reference-curves shift right by 1% between 2 weeks and 3 months. CF reference-curves did not change with manual artefact removal during sleep and did not vary between rapid eye movement (REM) and non-REM sleep. Manual artefact removal did significantly change summary statistics and CF reference-curves during wake.

Conclusions

SpO2CF curves provide an intuitive visual tool for evaluating whether an individual's nocturnal SpO2distribution falls within the range of healthy age-matched infants, thereby complementing summary statistics in the interpretation of extended oximetry recordings in infants.
The future burden of obesity-related diseases in the 53 WHO European-Region countries and the impact of effective interventions: a modelling study
Authors: Webber Laura , Divajeva Diana , Marsh Tim , McPherson Klim , Brown Martin , Galea Gauden , Breda Joao
Published: July 2014

Objective

Non-communicable diseases (NCDs) are the biggest cause of death in Europe putting an unsustainable burden on already struggling health systems. Increases in obesity are a major cause of NCDs. This paper projects the future burden of coronary heart disease (CHD), stroke, type 2 diabetes and seven cancers by 2030 in 53 WHO European Region countries based on current and past body mass index (BMI) trends. It also tests the impact of obesity interventions on the future disease burden.

Setting and participants

Secondary data analysis of country-specific epidemiological data using a microsimulation modelling process.

Interventions

The effect of three hypothetical scenarios on the future burden of disease in 2030 was tested: baseline scenario, BMI trends go unchecked; intervention 1, population BMI decreases by 1%; intervention 2, BMI decreases by 5%.

Primary and secondary outcome measures

Quantifying the future burden of major NCDs and the impact of interventions on this future disease burden.

Results

By 2030 in the whole of the European region, the prevalence of diabetes, CHD and stroke and cancers was projected to reach an average of 3990, 4672 and 2046 cases/100 000, respectively. The highest prevalence of diabetes was predicted in Slovakia (10 870), CHD and stroke—in Greece (11 292) and cancers—in Finland (5615 cases/100 000). A 5% fall in population BMI was projected to significantly reduce cumulative incidence of diseases. The largest reduction in diabetes and CHD and stroke was observed in Slovakia (3054 and 3369 cases/100 000, respectively), and in cancers was predicted in Germany (331/100 000).

Conclusions

Modelling future disease trends is a useful tool for policymakers so that they can allocate resources effectively and implement policies to prevent NCDs. Future research will allow real policy interventions to be tested; however, better surveillance data on NCDs and their risk factors are essential for research and policy.
Determinants of patient delay in doctor consultation in head and neck cancers (Protocol DEREDIA)
Authors: Christophe Véronique , Leroy Tanguy , Seillier Mélanie , Duthilleul Camille , Julieron Morbize , Clisant Stéphanie , Foncel Jérôme , Vallet Fanny , Lefebvre Jean-Louis
Published: July 2014

Introduction

Reducing the time between the onset of the first symptoms of cancer and the first consultation with a doctor (patient delay) is essential to improve the vital prognosis and quality of life of patients. Longer patient delay is linked to the already known sociodemographic, socioeconomic, socioeducational, sociocultural and socioprofessional factors. However, recent data suggest that some sociocognitive and emotional determinants may explain patient delay from a complementary point of view. The main objective of this study is to assess whether, in head and neck cancer, patient delay is linked to these sociocognitive and emotional factors, in addition to previously known factors.

Methods and analysis

We intend to include in this study 400 patients with a not yet treated head and neck cancer diagnosed in one of six health centres in the North of France region. The main evaluation criterion is ‘patient delay’. Sociocognitive, emotional, medical, sociodemographic, socioeconomic, educational, professional and geographic factors will be assessed by means of (1) a case report form, (2) a questionnaire completed by the clinical research associate together with the patient, (3) a questionnaire completed by the patient and (4) a recorded semidirective interview of the patient by a psychologist (for 80 patients only). The collected data will be analysed to underline the differences between patients who consulted a doctor earlier versus those who consulted later.

Ethics

The study has obtained all the relevant authorisations for the protection of patients enrolled in clinical trials (CCTIRS, CCP, CNIL), does not involve products mentioned in article L.5311-1 of the French Code of Public Health, and does not imply any changes in the medical care received by the patients. The study began in October 2012 and will end in June 2015.

Trial registration

ID-RCB 2012-A00005-38.
Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation
Authors: Rosell-Ortiz Fernando , Mellado-Vergel Francisco J , Fernández-Valle Patricia , González-Lobato Ismael , Martínez-Lara Manuela , Ruiz-Montero María M , Romero-Morales Francisco , Vivar Díaz Itziar , García-Alcántara Ángel , García del Águila Javier
Published: July 2014

Objective

Hospital mortality in myocardial infarction ST-elevation myocardial infarction has decreased in recent years, in contrast to prehospital mortality. Our objective was to determine initial complications and factors related to prehospital mortality in patients with acute myocardial infarction with ST segment elevation (STEMI).

Methods

Observational study based on a prospective continuous register of patients of any age attended by out-of-hospital emergency teams in Andalusia between January 2006 and June 2009. This includes patients with acute coronary syndrome-like symptoms whose initial ECG showed ST elevation or presumably new left bundle branch block (LBBB). Epidemiological, prehospital data and final diagnostic were recorded. The study included all patients with STEMI on the register, without age restrictions. Forward stepwise logistic regression analysis was performed to control for confounders.

Results

A total of 2528 patients were included, 24% were women. Mean age 63.4±13.4 years; 16.7% presented atypical clinical symptoms. Initial complications: ventricular fibrillation (VF) 8.4%, severe bradycardia 5.8%, third-degree atrial-ventricular (AV) block 2.4% and hypotension 13.5%. Fifty-two (2.1%) patients died before reaching hospital. Factors associated with prehospital mortality were female sex (OR 2.36, CI 1.28 to 4.33), atypical clinical picture (OR 2.31, CI 1.21 to 4.41), hypotension (OR 4.95, CI 2.60 to 9.20), LBBB (OR 4.29, CI 1.71 to 10.74), extensive infarction (ST elevation in ≥5 leads) (OR 2.53, CI 1.28 to 5.01) and VF (OR 2.82, CI 1.38 to 5.78).

Conclusions

A significant proportion of patients with STEMI present early complications in the prehospital setting, and some die before reaching hospital. Prehospital mortality was associated with female sex and atypical presentation, as pre-existing conditions, and hypotension, extensive infarction, LBBB and VF on emergency team attendance.
Network meta-analysis to evaluate the effectiveness of interventions to prevent falls in children under age 5 years
Authors: Hubbard Stephanie , Cooper Nicola , Kendrick Denise , Young Ben , Wynn Persephone M , He Zhimin , Miller Philip , Achana Felix , Sutton Alex
Published: July 2014

Background

This study aimed to simultaneously evaluate the effectiveness of a range of interventions to increase the possession of safety equipment or behaviours to prevent falls in children under 5 years of age in the home.

Methods

A recently published systematic review identified studies to be included in a network meta-analysis; an extension of pairwise meta-analysis that enables comparison of all evaluated interventionssimultaneously, including comparisons not directly compared in individual studies.

Results

29 primary studies were identified, of which 16 were included in at least 1 of 4 network meta-analyses. For increasing possession of a fitted stair gate, the most intensive intervention (including education, low cost/free home safety equipment, home safety inspection and fitting) was the most likely to be the most effective, with an OR versus usual care of 7.80 (95% CrI 3.08 to 21.3). For reducing possession or use of a baby walker: education only was most likely to be most effective, with an OR versus usual care of 0.48 (95% CrI 0.31 to 0.84). Little difference was found between interventions for possession of window locks (most intensive intervention versus usual care OR=1.56 (95% CrI 0.02 to 89.8)) and for not leaving a child alone on a high surface (education vs usual care OR=0.89 (95% CrI 0.10 to 9.67)). There was insufficient evidence for network meta-analysis for possession and use of bath mats.

Conclusions

These results will inform healthcare providers of the most effective components of interventions and can be used in cost-effectiveness analyses.
Spontaneous closure of a dural arteriovenous fistula
Authors: Al-Afif Shadi , Nakamura Makoto , Götz Friedrich , Krauss Joachim K
Published: July 2014

Spontaneous closure of a dural arteriovenous fistula (dAVF) is a rare condition and only a few cases have been reported since its first description in 1976. We report delayed and progressive spontaneous closure of a dAVF after massive intracerebral hemorrhage documented by angiographic studies before and after bleeding. To our knowledge, this is the first report to document gradual closure of a dAVF by serial angiographic studies. The mechanism of spontaneous closure of dAVFs has not been fully elucidated. We suggest different factors for consideration from previously published data and show how each of these factors can influence the others.
Immunohistochemical analysis of a ruptured basilar top aneurysm autopsied 22 years after embolization with Guglielmi detachable coils
Authors: Yuki Ichiro , Spitzer Daniel , Guglielmi Guido , Duckwiler Gary , Fujimoto Motoaki , Takao Hiroyuki , Jahan Reza , Tateshima Satoshi , Murayama Yuichi , Vinuela Fernando
Published: July 2014

The authors report on the histologic and immunohistochemical analyses of a cerebral aneurysm embolized with platinum coils and with the longest observation period. A 58-year-old woman presenting with subarachnoid hemorrhage due to ruptured basilar top aneurysm was treated with Guglielmi detachable coils (GDC) 22 years ago. She was the 15th case since the GDC was introduced. After she died of unrelated causes, an autopsy and thorough histologic examination were performed. Gross examination revealed no adhesion between the aneurysm wall and the surrounding brain tissue. Histologic and immunohistochemical analyses demonstrated that the cavity of the aneurysm was filled with homogeneous collagenous fibrous tissue, while the neck was completely covered by a dense collagenous neointima and a smooth muscle cell layer. The unique histologic results of this case may contribute to a better understanding of the long-term evolution of the healing process in intracranial aneurysms successfully treated with the GDC.
E-037 Single Center Comparison of Ophthalmic Aneurysm Treatment Using Pipeline Embolization Device Versus Coil Embolization
Authors: Durst C , Starke R , Gingras J , Hixson H , Liu K , Crowley R , Jensen M , Evans A , Gaughen J
Published: July 2014

Introduction/purpose

Aneurysms arising from the ophthalmic segment of the internal carotid artery (ICA) account for approximately 5% of all intracranial aneurysms. The Pipeline Embolization Device (PED) is a relatively new device available for treatment of these aneurysms. Here, we compare our experience with PED versus coil embolization in the treatment of unruptured ophthalmic artery aneurysms.

Materials and methods

A review of our prospectively collected patient log identified 106 patients who had undergone endovascular treatment of an unruptured ophthalmic artery aneurysm. Blinded to outcome, PED and coil patients were matched in a 1:2 fashion, respectively, based on aneurysm size. Matched analysis was carried out with marched t-test, Wilcoxon rank sum test, and McNamara’s test as appropriate. P-values of ≤ 0.05 were considered statistically significant. Statistical analysis was carried out with Stata 10.0 (College Station, TX).

Results

After matching the patients in a 1:2 fashion, there were 20 patients treated with PED and 40 treated by coil embolization. There were no statistically significant differences in age, sex, average aneurysm diameter, or maximum aneurysm diameter. There were significant differences between the two groups in length of follow up, phase of treatment, baseline mRS, presentation, and neck size.

Morbidity was 2.5% in the coiled cohort and 10% in the PED cohort (p = 0.255). Note, however, that in 1 of the 2 complications in the PED group, the patient was not compliant with their dual anti-platelet therapy. Immediate occlusion rates favored coil embolization as would be expected. However, recurrences were more frequent in the coiled group (22 vs 0%, p = 0.046).

Conclusions

This study suggests that complications may be more frequent with PEDs, but treatment may be more permanent as evidenced by the lower recurrence rate.

Disclosures

C. Durst: None. R. Starke: None. J. Gingras: None. H. Hixson: None. K. Liu: None. R. Crowley: None. M. Jensen: 2; C; Covidien. A. Evans: 2; C; Covidien, Stryker. J. Gaughen: 2; C; Covidien, Stryker, Microvention.
E-039 Safety and Efficacy of Flow Diverter Treatment for Carotid-Ophthalmic Aneurysms
Authors: Grossberg J , Tong F , Cawley C , Dion J
Published: July 2014

Introduction/purpose

The purpose of this study was to determine the efficacy and safety of flow diversion technology in the treatment of aneurysms of carotid-ophthalmic aneurysms.

Materials and methods

This study retrospectively reviewed outcomes in 45 consecutive patients with carotid-ophthalmic aneurysms who were treated with Pipeline Embolization Device (PED) by three separate neuro-interventionalists. A chart review was performed to collect information on demographics, aneurysm size, treatment outcomes, and procedure-related complications. The primary end-points were rate of aneurysm occlusion and ophthalmic artery patency, as assessed by angiographic images. The secondary end point was peri- and post-procedural complications were evaluated. Descriptive statistical analysis was performed.

Results

There were 39 females and 6 males in the study. The average age was 56.4 (range 31–81). Thirty-two patients had a single aneurysm treated during the PED procedure; multiple aneurysms were treated in 13 cases. All of the aneurysms treated were unruptured. Seven aneurysms were recurrences of prior coil embolization procedures. The average aneurysm size was 8.9 mm (range 2.1–26). The treated aneurysm measured <10 mm in 28 cases. The average neck size was 5.3 mm (range 1.6–9.3 mm). Patients were treated with one PED in 32 cases, two PEDs in 10 cases, three PEDs in 2 cases, and four PEDs in 1 case. Eleven cases were treated with coiling in addition to PED placement.

The PED was successfully deployed in 44 of 45 cases. There were two mortalities (4.4%) within 30 days of treatment-one from a large intraparenchymal haemorrhage and one from unknown causes. Other 30-day complications included capture coil fracture (2), reversible intra-procedural thrombosis (2), small contralateral convexity subarachnoid haemorrhage (1), and symptomatic embolic infarcts (1). There were no complications seen after 30 days.

Six month angiographic follow-up was available in 37. There was complete aneurysm occlusion in 27 patients (73%). There was minimal residual aneurysm filling in eight patients (22%) and only slightly decreased aneurysm filling in two patients (5%). There was only one instance (3%) of ophthalmic artery occlusion noted, and this was asymptomatic.

Conclusion

Flow diversion treatment for carotid-ophthalmic aneurysms has a high rate of aneurysm occlusion, while maintaining a low complication rate.

Disclosures

J. Grossberg: None. F. Tong: None. C. Cawley: None. J. Dion: None.
E-041 Use of Flow Diverters in the Endovascular Reconstruction of Fusiform Dissecting Vertebral Artery Aneurysms
Authors: Puri A , Massari F , Hou S , Perras M , Brooks C , Stout C , Gounis M , Wakhloo A
Published: July 2014

Introduction/purpose

Fusiform aneurysms (FUANs) of vertebral artery are difficult to treat by using current surgical techniques. Endovascular techniques like parent vessel occlusion, trapping, coiling, stent assisted coiling or stent mono-therapy is currently used to treat these aneurysms. The purpose of this study is to assess the efficacy and safety of flow diverters (Pipeline Embolization Device) in the treatment of vertebral artery FUANs compared to currently used therapeutic modalities.

Materials and methods

From July 2012 to October 2013, a total of 5 vertebral artery fusiform dissecting aneurysms in 5 patients (2 men and 3 women; age range, 39–59 years; mean age, 50.8 years) were treated with pipeline embolization device (PED) at our institution. In 2 patients the aneurysms were an incidental finding whereas in the other 3 cases were associated to neurologic symptoms, such as visual changes, ataxia, facial numbness or vertigo. Location of the aneurysms was as follows: 4 aneurysms on the right and 1 on the left side. 4 aneurysms were centerd at the V4 segment of the vertebral artery (intradural); only one was located at the vertebral V3-V4 segments junction (intra/extradural). Only one patient had family history indicative for intracranial aneurysm. Aneurysms ranged from 5 to 13 mm in maximal diameter. The technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcome were evaluated.

Results

In every case, endovascular treatment was achieved. Immediate angiography demonstrated intra-aneurysmal contrast stagnation, with parent artery preservation in all cases. Major procedure-related complications were not observed. A brief temporary episode of dysarthria was noted in one of the patient. None of the treated aneurysms experienced bleeding or thrombo-embolic complication during the follow-up time. At 6 month follow-up (4 patients) was noted a complete/near complete aneurysm obliteration in 3 patients and partial obliteration in 1 patient. At 1 year follow-up (2 patients) was noted a progression to complete aneurysm obliteration in 1 patient and stable partial embolization in 1 patient. No intimal hyperplasia was noted at 6–12 months follow-up in the cohort of patients analyzed.

Conclusion

In our preliminary experience vertebral artery fusiform dissecting aneurysms treatment with PED is a safe and efficacious option in treating dissecting or fusiform intracranial aneurysms. Long term studies and larger cohort is recommended for further evaluation of this treatment strategy.

Disclosures

A. Puri: None. F. Massari: None. S. Hou: None. M. Perras: None. C. Brooks: None. C. Stout: None. M. Gounis: None. A. Wakhloo: None.
E-042 Use of Flow Diverters in Vessels less than 2.5 mm during Intracranial Aneurysm Treatment
Authors: Puri A , Massari F , Hou S , Perras M , Brooks C , Stout C , Gounis M , Wakhloo A
Published: July 2014

Introduction/purpose

Pipeline Embolization Device (PED) is currently indicated for treatment of large and complex intracranial aneurysms centerd along the cavernous/intradural segment of the internal carotid artery (ICA) proximal to the Posterior Communicating (PCom) artery. The purpose of this study is to assess the efficacy and safety of flow diversion treatment in unruptured complex aneurysms centerd along small vessel branches of the anterior and middle cerebral arteries.

Materials and methods

From August 2013 to December 2013, a total of 3 intracranial aneurysms located along small vessel branches of the anterior circulation in 3 patients (1 man and 2 women; age range, 60–71 years; mean age, 64.6 years) were treated with pipeline embolization device (PED) at our institution. In 2 patients the aneurysms were incidentally found during cerebral angiogram exam performed for additional unruptured intracranial aneurysm treatment planning; in the other case the aneurysm was prior source of a subarachnoid haemorrhage (SAH). The parent vessel size ranged from 1.8 to 2.2 mm, mean 2 mm. Location of the aneurysms was as follows: 2 aneurysms centerd along the pericallosal artery (1 left, 1 right), branch of the anterior cerebral artery (ACA), and 1 aneurysm located on the right angular artery, branch of the middle cerebral artery (MCA). In the patient group no family history for intracranial aneurysm is reported. Aneurysms ranged from 2.5 to 3.7 mm in maximal diameter. The technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcome were evaluated. At 6 month follow-up (1 patient) was noted a complete right angular artery aneurysm obliteration, with mild in-PED intimal hyperplasia.

Results

In every case, endovascular treatment was achieved. Immediate angiography demonstrated a intra-aneurysmal contrast stagnation, with parent artery preservation. No major or minor procedure-related complications were noticed. None of the treated aneurysms experienced bleeding or thrombo-embolic complication intra-, post procedurally or on follow-up.

Conclusion

Although the experience is limited by the small volume of cases treated with PED for unruptured complex aneurysms centerd along less than 2.5 mm vessel branches of the anterior circulation, the procedure was noted to be a feasible, safe and effective method to obtain aneurysm occlusion without parent vessel occlusion.

Disclosures

A. Puri: None. F. Massari: None. S. Hou: None. M. Perras: None. C. Brooks: None. C. Stout: None. M. Gounis: None. A. Wakhloo: None.
E-044 A Multicenter Case Review Study to Assess Radiation Exposure (CARE) in the Treatment of Intracranial Aneurysms with the Penumbra Coil 400
Authors: Chowdhary A
Published: July 2014

Purpose

Radiation exposure during an angiographic procedure may present a significant health risk to patients. The goal of this multicenter case study (CARE) is to compare such exposure in patients treated with the novel Penumbra Coil 400™ System (PC 400) vs. conventional coils. The PC 400 coils are a new generation of platinum embolic coils designed specifically to enhance filling efficiency, which can allow faster procedure times. This could lead to less radiation exposure than with conventional coils in comparable size aneurysms.

Methods

CARE will enrol up to 90 patients, including the control group, presenting with intracranial aneurysms at 15 centers in the USA. They will receive coil embolization therapy with the PC 400 or conventional coils (2:1) in accordance with the cleared indications for use. Adjunctive use of stents, balloons or liquid embolics is permitted. The primary endpoints are: 1) Acute radiation exposure at immediate post-procedure [air kerma, kerma-area product (KAP) or dose area product (DAP), and fluoroscopic time]; 2) Procedural serious adverse events up until 3 days or discharge, whichever occurs first.

Results

It is predicted that patient enrollment will require 12 months. Patients will be monitored and assessed until 3 days after the coiling procedure or discharge from the hospital (whichever occurs first). IRB approval is pending for this study.

Conclusion

Limited literature is available about treatment-related radiation exposure in patients treated by the PC 400. We hypothesise that due to the unique large volume of these coils, procedural time for embolic coiling of intracranial aneurysms may be shortened over conventional coils, leading to significantly lower radiation exposure.

Disclosures

A. Chowdhary: None.
E-051 Classification of Cavernous Internal Carotid Artery Tortuosity: A Predictor of Procedural Complexity in Pipeline Embolization
Authors: Uwandu C , Lin L , Colby G , Huang J , Tamargo R , Coon A
Published: July 2014

Background

Endoluminal reconstruction of a diseased parent artery with flow diverters is increasingly used for the treatment of intracranial aneurysms. The complexity of these procedures can be highly variable. Understanding the degree of tortuosity of the cavernous internal carotid artery (ICA) may help predict procedural complexities of deploying flow diverters such as the Pipeline embolization device (PED).

Methods

We retrospectively reviewed a prospective, single-center aneurysm database to identify all patients with ICA aneurysms proximal to the posterior communicating artery who underwent endovascular treatment using the PED with the Navien distal intracranial guide catheter. Cavernous ICA (cICA) tortuosity was measured as a ratio between the height difference of the cICA anterior and posterior genus (D) to the sum of the angles of the anterior and posterior genus (AP). Identified patients were categorized into three groups based on cICA tortuosity. An analysis of variance regression was performed to detect differences among the three groups as they relate to procedural fluoroscopy time length, cICA tortuosity (D/AP), and aneurysm size.

Results

Seventy-eight cICA were analyzed and the degree of tortuosity was categorized into minimal (group I, n = 26), moderate (group II, n = 28), and severe or “Simmons-type” (group III, n = 24). The three groups were comparable with relation to patient age (mean group I – 55.5, II – 55.0, III – 55.9) and aneurysm size (mean group I – 6.2 mm, II – 7.8 mm, III – 9.0 mm). Analysis of variance demonstrated significant differences in procedural fluoroscopy time (FT) and degree of cICA tortuosity (D/AP). Mean FT was greater in group III (50.3 + 13.5) compared to group II (42.3 + 33.3) and group I (30 + 8.4), p value <0.005. Similarly, mean D/AP was significantly higher in group III (0.49 + 0.38) compared to groups II (0.14 + 0.07) and I (0.008 + 0.0008), p value <0.005. In group I, PED deployment was successful in 100% of cases whereas groups II and III had 2 and 1 unsuccessful cases respectively.

Conclusion

In this study, we propose a classification system for cICA tortuosity based on measurements of the anterior and posterior genu geometry. This classification correlates strongly with markers of PED procedural complexity and may be helpful in pre-procedure prognostication.

Disclosures

C. Uwandu: None. L. Lin: None. G. Colby: None. J. Huang: None. R. Tamargo: None. A. Coon: 2; C; ALC is a proctor for the Pipeline Embolization Device (Covidien, Mansfield, Massachusetts, USA) and a consultant for Covidien.
O-012 Demographic and Lesion Characteristics Outperform Degree of Stenosis in Predicting Outcomes Following Stenting for Symptomatic Intracranial Atherosclerosis
Authors: Alexander M , Cooke D , Meyers P , Amans M , Narvid J , Dowd C , Halbach V , Higashida R , Hetts S
Published: July 2014

Introduction

Intracranial atherosclerotic disease (ICAD) is often stratified by degree of stenosis. Additional features such as patient demographics and symptom characteristics also affect lesion behavior and response to treatment. This study compares stratification by degree of narrowing to these additional features.

Materials and methods

Retrospective analysis was performed on patients at 4 hospitals with ICAD causing stroke or transient ischemic attack (TIA) treated with stents. Patient demographics, lesion features, symptom characteristics, treatment success, and post-treatment outcomes such as technical complication, transient ischemic attack, stroke, or death were noted. Symptom characteristics were divided by aetiology as hypoperfusion, non-hypoperfusion, or indeterminate. Univariate logistic regression was performed for nominal variable types, and decision trees were constructed using recursive partitioning for continuous variables.

Results

Chi-square univariate logistic regression analysis demonstrated significant correlation of female gender with stroke at 30 days (x2[1, n = 130] = 5.106, p = 0.024). At point of last clinical contact, TIA was associated with an indeterminate symptom aetiology as opposed to identifiable hypoperfusion or non-hypoperfusion aetiology (x2 [1, n = 130] = 5.556, p = 0.018), as was initial presentation with TIA rather than stroke (x2[1, n = 130] = 6.458, p = 0.011). When comparing non-hypoperfusion and indeterminate symptom etiologies against clearly identifiable hypoperfusion aetiology, the non-hypoperfusion group was more likely to have a stroke by point of last contact (x2[1, n = 130] = 7.664, p = 0.006). Stroke outcome was also associated with lesion stenosis >95% (x2[1, n = 130] = 5.709, p = 0.017). Recursive partitioning analysis confirmed the above-described results and identified age >76.6 years as associated with symptomatic technical complications (x2[1, n = 130] = 0.047).

Conclusion

Degree of atherosclerotic stenosis is commonly used to stratify lesions when assessing suitability for treatment. This study identified stronger prognostic value in lesion features, specifically pathophysiologic features of presenting symptoms, and patient age and sex. Further research is needed to develop more robust models to predict natural history and potential response to endovascular treatment for ICAD.

Disclosures

M. Alexander: None. D. Cooke: None. P. Meyers: None. M. Amans: None. J. Narvid: None. C. Dowd: None. V. Halbach: None. R. Higashida: None. S. Hetts: None.
E-055 Incidence of External Ventricular Drainage Placement on Rebleeding of Ventricular Arteriovenous Malformations
Authors: Robert T , Blanc R , Gilboa B , Ciccio G , Fahed R , Redjem H , Pistocchi S , Bartolini B , Piotin M
Published: July 2014

Background

Intraventricular arteriovenous malformation (AVM) is an exceptional but well recognised source of intraventricular haemorrhage. The impact of external ventricular drainage (EVD) for acute hydrocephalus on AVM rebleeding has not been yet reported in the literature.

Methods

Since 1995, clinical and angiographic data of cerebral AVMs were prospectively collected. In this study, we selected patients harbouring an AVM located in a lateral ventricle discovered by a bleeding. The implication of following factors on rebleeding was analyzed: age, sex, associated aneurysm, nidus size and type, venous ectasia, Spetzler-Martin grade, placement of EVD and side of the drainage.

Results

Twenty-two patients (mean age 27.9 years) were consecutively treated. Locations of the AVM included the atrium in 13 cases (59.1%), the frontal horn in 12 cases (54.6%) and the occipital horn in 2 cases (9.1%). 9 AVMs (40.9%) interested eloquent areas. The Spetzler-Martin grade was II in 10 cases (45.5%), III in 3 (13.6%), IV in 8 (36.4%) and V in 1 case (4.5%). Associated aneurysms were classified as nidal (2 cases, 9.1%), flow-related (2 cases, 9.1%) and unrelated to the AVM (3 cases, 13.6%). Ten (45.5%) patients developed a secondary hydrocephalus. Five EVD were placed in the ventricle of the AVM and the five other in the contralateral ventricle. The placement of the shunt in the contralateral ventricle was a significant risk factor AVM rebleeding (95% CI: 4.33–10.42, p < 0.005). The presence of an associated aneurysm, diffuse type of the nidus and the placement of EVD seemed to be risk factors for the rebleeding of the AVM.

Conclusions

The placement of EVD in the opposite side of the AVM significantly increased the risk of rebleeding of the AVM. We recommend the placement of EVD in the side of the AVM even if the obturation of the shunt could be problematic also as the avoidance of the nidus by the catheter.

Disclosures

T. Robert: None. R. Blanc: None. B. Gilboa: None. G. Ciccio: None. R. Fahed: None. H. Redjem: None. S. Pistocchi: None. B. Bartolini: None. M. Piotin: None.
E-056 Pipeline Endovascular Device for the Treatment of Intracranial Aneurysm at the Level of the Circle of Willis and Beyond: Multicenter Experience
Authors: Martínez-Galdámez M , Linfante I , Lin E , Dabus G
Published: July 2014

Background and purpose

The aim of our study was to evaluate the safety and eficacy of the Pipeline endovascular device for the treatment of anterior circulation aneurysms at the level of circle of Willis and beyond.

Methods

A consecutive series of 23 patients with unruptured and 1 with ruptured anterior circulation aneurysms treated with Pipeline endovascular device. Complication rates, aneurysm obliteration, modified Rankin Scale (mRS) outcomes were assessed.

Results

All devices were placed properly, without technical difficulties.

We found 1 minor clinical event (resolved within 7 days from procedure) and 1 major event (symptoms present after 7 days) (table), and no mortality.

There were no aneurysm rupture or parenchymal haemorrhage during follow-up.

The mRS at 3 and 6 months did not change from prior mRS in all cases but 1.

We had 2 asymptomatic periprocedural ischemic events: 1 perforator stroke in the case of a recanalised A1-A2 where we used 2 PEDs, and 1 lacunar stroke. Both cases were discovered incidentally at the control CT predischarge.

We had 3 intraprocedural complications, resolved without clinical consequences:1 acute branch occlusion during hypotension state which was solved after TA raise (case 4), 1 slow opacification of the inferior trunk of MCA resolved with intraarterial bolus of reopro (case 20), and 1 focal SAH secondary to distal perforation with the microwire during and exchange manoeuvre which was resolved with coil occlusion and glue at the level of the perforation, with no symptoms (case 14)

Six-month follow-up angiograms were obtained in 16 aneurysms, showing complete occlusion in 9 and significantly decreased residual filling in 7.

5 cases are still pending on 6 months DSA and 1 case showed residual filling at the 3 months follow-up.

Patency of PEDs and status of branches originating from the aneurysm sacs were evaluated in 17 and 11 angiograms respectively.

All PEDs were patent, but we found 4 intrastent stenosis at 6 months DSA where only 1 symptomatic case (an angioplasty was done successfully).

In the 11 branches evaluated, 7 were patent, 2 moderate reduced and in 2 cases were occluded asymptomatically.

Conclusion

The PED provides a safe and effective solution for aneurysms at and beyond the circle of Willis. Preliminary results are promising but larger series with longer-term follow-up examinations are required to show the long-term safety and durability of this treatment alternative.

Disclosures

M. Martínez-Galdámez: 2; C; Covidien. I. Linfante: 2; C; Covidien, Stryker, Codman. E. Lin: None. G. Dabus: 2; C; Covidien, Microvention, Reverse Medical.
E-062 Intracranial Stenting for Atherosclerotic Disease with Aggressive Anti-platelet Therapy Management: A Consecutive Series of 154 Patients
Authors: Alexander M , Nuno M , Alexander J , Agutos C , Yu W
Published: July 2014

Introduction

Contemporary studies of intracranial stenting have utilised standard or aggressive medical therapy involving dual anti-platelet therapy, but have not evaluated anti-platelet therapy resistance as a component of treatment failure.

Methods

The current study evaluates a prospective aggressive anti-platelet therapy management approach at two institutions in a consecutive series of 154 patients with symptomatic intracranial atherosclerotic disease (ICAD) treated with angioplasty and stenting with the Wingspan self-expanding nitinol stent. Anti-platelet medication therapeutic effects of aspirin and clopidogrel were measured prior to the procedures by platelet function assay, thromboelastography, aggregometry, or Accumetrics VerifyNow systems. Medications were adjusted or changed for subtherapeutic or supratherapeutic values with clopidogrel goal inhibition of 20–80% and aspirin reactive unit (ARU) less than 550.

Results

A total of 154 patients with symptomatic ICAD were treated from 2005 to 2014. The periprocedural complication rate was 3.9% (6/154) with 1 subarachnoid haemorrhage, 0 intraparenchymal haemorrhages, 5 perforator strokes, and no stent thrombosis. With a mean follow up of 2.3 years, the total ipsilateral stroke and death rate was 6.5% (10/154). The relative aspirin resistance rate was 7.8% and the relative clopidogrel resistance rate was 14.9% in this series. Eight of the patients (5.2%) required repeat angioplasty for symptomatic re-stenosis within the first year. The mean time to treatment was 10.7 days following the last stroke.

Conclusions

With aggressive monitoring and management of anti-platelet medications, intracranial stenting complications of stent thrombosis and distal emboli can be reduced, although there is still a significant risk of perforator strokes, particularly in the middle cerebral artery and basilar distributions.

Disclosures

M. Alexander: 1; C; Stryker Neurovascular. M. Nuno: None. J. Alexander: None. C. Agutos: None. W. Yu: 1; C; Stryker Neurovascular.
O-013 How Tough is the Interventional Life, the Heart Rate of a Neurointerventionalist
Authors: Brouwer P
Published: July 2014

Performing neurointerventional procedures can in some cases be considered demanding. Some procedures are straightforward but we all face situations where our heart rate and blood pressure seem to rise considerably.

In this presentation a graphic representation will be given of the operators’ monitored heart rate during a variety of illustrative procedures.

Disclosures

P. Brouwer: None.
E-074 Emergency Carotid Artery Stenting in Acute Ischemic Stroke
Authors: Ohara N , Tateshima S , Sayre J , Duckwiler G , Jahan R , Gonzalez N , Vespa P , Ali L , Saver J , Liebeskind D
Published: July 2014

Introduction/purpose

Recanalization of occluded arteries is crucial for good functional outcome of acute stroke patients with large vessel occlusion. Endovascular treatment, particularly mechanical thrombectomy, plays an increasing role to achieve rapid recanalization. However, some patients with acute large vessel occlusion have additional extracranial cervical carotid artery occlusion or severe stenosis. Although these patients might undergo carotid stenting to achieve recanalization of intracranial occlusions, such stenting causes challenges in subsequent clinical management. The purpose of this study was to evaluate the safety and efficacy of endovascular recanalization treatment with emergency carotid artery stenting for acute stroke patients.

Materials and methods

We analyzed clinical and angiographic data of patients who underwent emergency cervical internal carotid artery (ICA) stenting in the setting of acute endovascular recanalization treatment in our institution between May 2005 and December 2012. Reperfusion was assessed according to the modified Thrombolysis in Cerebral Infarction (mTICI) score. Clinical outcome was evaluated at discharge and at 3 months after treatment by modified Rankin Scale (mRS).

Results

23 patients were included in this cohort. The mean age was 63.3 years. The median NIHSS score on admission was 20 (range, 3–25). The median Alberta Stroke Program Early CT Score on diffusion-weighted imaging (ASPECTS-DWI) on admission was 7 (range, 2–10). 17 patients (73.9%) had ICA occlusion at the origin. 19 patients (82.6%) had intracranial tandem vessel occlusions. All patients successfully underwent carotid artery stenting and 15 patients (65.2%) underwent additional mechanical thrombectomy for intracranial vessels. After the procedure, 9 patients (39.1%) were mTICI grade >IIb. Haemorrhagic transformation with parenchymal hematoma occurred in 9 patients (39.1%) and 2 (8.7%) was symptomatic. At discharge and at 3-months follow-up, 6 patients (26.1%) had a favorable outcome (mRS0–2). The multiple logistic model yielded age (P = 0.018) and initial ASPECTS-DWI (P = 0.029) independently associated with a favorable outcome and additionally mechanical thrombectomy (P = 0.003) was associated with haemorrhagic transformation with parenchymal hematoma.

Conclusion

Endovascular recanalization treatment with emergency carotid artery stenting is technically feasible. Further refinement of patient selection may reduce postprocedural hemorrhaghic transformation and optimise resultant clinical outcomes.

Disclosures

N. Ohara: None. S. Tateshima: None. J. Sayre: None. G. Duckwiler: None. R. Jahan: None. N. Gonzalez: None. P. Vespa: None. L. Ali: None. J. Saver: None. D. Liebeskind: None.
O-019 Re-treatment Rates Following Pipeline Embolization Device Alone versus Pipeline and Coil Embolization of Cerebral Aneurysms: A Single Center Experience
Authors: Park M , Nanaszko M , Sanborn M , Moon K , Albuquerque F , McDougall C
Published: July 2014

Introduction

The introduction of the Pipeline Embolization Device (PED, eV3 Neurovascular, Irvine, California) has increased the complexity of the cerebral aneurysms which can be treated with neuro-interventional techniques. We sought to compare the recurrence rates following PED alone versus PED and coil embolization (PED/coil) of intracranial cerebral aneurysms in our single center.

Materials and Methods

We retrospectively examined a prospectively maintained endovascular database for cerebral aneurysms treated with the PED with or without coils from May 2011 to the present time. One hundred and thirty three patients (25 males, 108 females; age range 23–85 years; average 60.4 yrs) were treated for 140 aneurysms (average size 11.8 mm, SD 8.3 mm) requiring 224 PED (1.7 PED/pt) during the study period. Sixty-eight patients (13 males, 55 females) were treated with PED alone for 72 aneurysms (average 10.7mm, SD 9.2 mm). Whereas, 65 patients (12 males, 53 females) were treated with PED/coil of 67 aneurysms (average 12.8 mm, SD 7.0 mm)

Results

Eight aneurysms in eight patients were re-treated in the PED alone cohort versus only one aneurysm in one patient in the PED/coil cohort for an 11.7% (8/68) versus 1.5% (1/65) re-treatment rate respectively. The average time for re-treatment in the PED alone cohort was 6.5 months (SD 3.8) while the PED/coil re-treatment occurred at 10 months. Two patients in the PED cohort were re-treated due to PED contraction/migration while the other six patients were re-treated for enlargement or persistent filling of the aneurysms. The PED/coil patient had significant improvement in the aneurysm filling, but had small persistent endoleak into the aneurysm.

Conclusions

In our single center experience, PED/coil of cerebral aneurysms resulted in a lower re-treatment rate compared to PED alone. This result may provide the basis for future evaluation with randomised, controlled trials.

Disclosures

M. Park: None. M. Nanaszko: None. M. Sanborn: None. K. Moon: None. F. Albuquerque: None. C. McDougall: None.
O-023 Embolization with a Novel Endovascular Coil in a Canine Intracranial Saccular Aneurysm Model
Authors: Jahan R
Published: July 2014

Introduction

Endovascular treatment of aneurysms with coils is based on the assumption that dense packing leads to intra-aneurysmal flow reduction with subsequent thrombosis and occlusion. Despite significant advances in technology, anatomic results remain suboptimal with residual and recurrent aneurysms being a drawback of the coiling procedure. In this report we describe a novel device for treatment of intracranial aneurysms and report safety, technical feasibility and anatomic outcomes in a canine aneurysm model.

Materials and methods

This study tested novel endovascular coils (Medina Medical, Menlo Park, California) consisting of a linear radiopaque mesh that, when deployed, self-expands to a three-dimensional shape that conforms to the aneurysm. Coils were deployed via standard endovascular techniques in surgically-created carotid aneurysms in canines. Device performance and procedural angiographic data were collected. Animals were survived through 30, 90, or 180 days when follow-up angiography was performed followed by sacrifice and histopathologic evaluation.

Results

38 aneurysms in 22 animals were evaluated. The average dome size was 7.5 mm (SD: 1.2; range: 5.3–10.4) with an average neck of 4.2 mm (SD: 0.7; range: 2.8–6.1). There was no vasospasm, parent vessel thrombus or device migration during the procedure. In 27 aneurysms (71%), one coil was implanted. 35 aneurysms (92%) required two or fewer coils. Implanting physician ratings of device usability factors averaged 4.7 out of a maximum rating of 5.

At follow-up, 25 aneurysms (69%) showed angiographic occlusion of 90–100%. Subsequent histologic analysis demonstrated that 27 aneurysms (75%) were completely occluded with mature fibrous tissue. Two device migrations occurred in the post-operative period. No evidence of thrombosis or device corrosion was found in any animal. Inflammation was minimal and of a chronic nature.

Conclusion

The technical feasibility of this embolization coil for occlusion of saccular aneurysms was demonstrated and usage ratings were positive. In contrast to reports of platinum coils in aneurysms of similar size, relatively few devices were required for each aneurysm; most required only one or two coils.

The device was effective at all chronic follow-up time points, with at least two-thirds of aneurysms showing 90% or greater occlusion. Complete aneurysm occlusion with organised fibrocellular tissue seen in the majority of cases may result in a permanent and stable occlusion that could result in fewer recanalizations and minimise the need for re-treatments. Overall, this initial report of preclinical outcomes with a new embolization coil reveals promising results.

Disclosures

R. Jahan: 2; C; Covidien, Medina Medical, Stryker.