bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-004 Retreatment and Rebleed Rates of Coiled Aneurysms with Respect to the Raymond-Roy Scale, a Meta Analysis
Authors: Darflinger R , Urdaneta A , Chao K , Feng L 
Published: July 2013

IntroductionWe tend to use the Raymond-Roy scale for aneurysm occlusion although its significance in terms of long term durability and outcome has not been established. Although there is a tendency of higher recurrence after initial aneurysm coiling with higher grades, the retreatment rates and rebleed rates are less understood. We conducted a meta-analysis to study the retreatment and rebleed rates after initial aneurysm coiling.MethodWe performed a meta-analysis utilising publications in pubmed for cerebral aneurysm coiling retreatment and rebleed. We then analysed papers with data that provided initial aneurysm coiling results using the Raymond-Roy system or some variation. We selected data with at least 1 year follow up. Given staged treatment, we defined retreatment as occurring greater than 3 month to exclude intentionally incomplete treatment. Rebleed was defined as greater than 1 month to exclude periprocedural complications.ResultsInitial angiographic results after aneurysm coiling utilising Raymond-Roy scale: grade 1 - 53%, grade 2 - 34%, grade 3 - 13%. For those aneurysms with initial grade 1 occlusion, there was 11% recurrence, 5% retreatment, and <1% rebleed. For those aneurysms with initial grade 2 neck remnant, there was 16% recurrence, 4% retreatment, and <1% rebleed. For those aneurysm with initial grade 3 residual aneurysm, there was 18% recurrence, 11% retreatment, and <1% rebleed. Although there was a difference in aneurysm recurrence after initial treatment, grade 1 and 2 demonstrated no significant difference in retreatment and rebleed.ConclusionThe Raymond-Roy scale provides predictive value for recurrence but less predictive value for retreatment and rebleed of cerebral aneurysms after coiling. Furthermore, grade 1 and 2 coiled aneurysms may not have any impact on clinical outcome given similar rates of retreatment and rebleed.DisclosuresR. Darflinger: None. A. Urdaneta: None. K. Chao: None. L. Feng: None.
P-007 Flow Diversion versus Traditional Aneurysm Embolisation Strategies: Analysis of Fluoroscopy and Procedure Times
Authors: Chalouhi N , McMahon J , Moukarzel L , Starke R , Jabbour P , Dumont A , Tjoumakaris S , Rosenwasser R , Gonzalez L 
Published: July 2013

Background and PurposeFlow diverters are increasingly used for treatment of complex intracranial aneurysms. The goal of this study was to compare the Pipeline Embolisation Device (PED) and traditional embolisation strategies in terms of fluoroscopy and procedure time.MethodsFluoroscopy and procedure times in minutes were retrospectively analysed and compared between 127 patients treated with PED, 86 patients treated with single-stage SAC, and 16 patients treated with Onyx HD 500 at our institution. A multivariate logistic regression analysis was performed to determine independent predictors of fluoroscopy and procedure time.ResultsThe 3 groups were comparable with respect to patient age, gender, and ruptured/ unruptured aneurysm status. Aneurysms treated with PED were significantly larger than stent-coiled aneurysms and aneurysm location distribution differed significantly between the 3 groups. Mean fluoroscopy time was significantly increased in the SAC (55 ± 31 min, p>0.001) and Onyx HD 500 (91 ± 36 min, p>0.001) groups relative to PED (34 ± 23 min). Likewise, mean procedure time was significantly longer in SAC (155 ± 50 min, p>0.001) and Onyx HD 500 patients (176 ± 65 min, p>0.001) compared to PED (131 ± 36 min). Mean fluoroscopy and procedure times remained significantly longer in SAC and Onyx HD 500 patients compared with those who underwent placement of more than 1 PED. In multivariate analysis, SAC/Onyx HD 500 vs PED independently predicted both longer procedure and fluoroscopy times.ConclusionPED treatment requires significantly shorter fluoroscopy and procedure times compared with SAC and Onyx HD 500. The results of this study may be used by advocates of flow diverters as an additional argument for using this treatment modality to treat intracranial aneurysms.DisclosuresN. Chalouhi: None. J. McMahon: None. L. Moukarzel: None. R. Starke: None. P. Jabbour: None. A. Dumont: None. S. Tjoumakaris: None. R. Rosenwasser: None. L. Gonzalez: None.
P-012 Endovascular Management of Inoperable Meningioma
Authors: Yakes W 
Published: July 2013

PurposeTo determine the efficacy of ethanol embolisation of single and multiple meningiomas in poor surgical candidates and in recurrent lesions.Materials and Methods11 patients (8 female, 3 male; mean age 52 yrs) underwent clinical, MR, and arteriographic evaluations. In patients who had post-surgical recurrence and/or were poor operative risks, ethanol embolisation was offered as an alternative procedure. Two patients that had multiple meningiomas related to Von Recklinghausen’s Neurofibromatosis Type II were offered endovascular ethanol treatments as multiple surgical craniotomies with excision were not possible.ResultsAll patients underwent ethanol embolisation of single and multiple pedicles supplying the tumour. Four patients suffered complications (1 patient minor late SAH without sequelae, 2 patients transient 6th nerve palsy, 1 patient transient worsening for 2 weeks of his aphasia). MR and CT demonstrated significant necrosis and shrinkage of the tumours at long-term follow-up (range: 6–72 mos; mean: 30 mos).ConclusionEthanol, being a liquid agent, penetrates to the capillary level causing necrosis and exclusion of collateral flow. This leads to tumour necrosis and shrinkage. Taking advantage of the slow-growing, non-metastasising characteristics and increased vascularity of this tumour, ethanol is an attractive alternative therapy that is minimally invasive. This treatment can be offered in selected poor surgical patients and in patients who developed post-operative recurrence. This procedure is efficacious in highly vascular tumours and in poorly vascularised meningiomas that are not possible to treat by endovascular approaches.DisclosuresW. Yakes: None.
E-010 Prolonged Neurologic Deterioration Following Acetazolamide Testing in the Acute Phase Following Ischaemic Stroke
Authors: Tawk R , Eidelman B , Hanel R , Meschia J , Barrett K 
Published: July 2013

BackgroundAcetazolamide induces cerebral vasodilatation and may be used to measure cerebrovascular reserve in patients with cerebral arteriopathy. While acetazolamide is known to induce transient neurologic deficits as a result of “steal phenomenon,” prolonged deficits have rarely been described.MethodsRetrospective, single-centre case review from 2011 to 2012.ResultsWe describe 3 patients ages 41, 60 and 65 years (2 women; 1 man) who developed prolonged neurological deterioration following administration of acetazolamide in the acute phase following presentation for evaluation of cerebrovascular reserve. Two patients presented with hemispheric ischaemic symptoms; one presented with headache and parietal convexity subarachnoid haemorrhage.One patient had extensive intracranial vascular disease consistent with a moyamoya-like syndrome with left middle cerebral artery (MCA) occlusion and severe left supraclinoid internal carotid artery (ICA) stenosis.Another had 50% left MCA stenosis as well as > 70% stenosis of the left ICA. She failed medical therapy, L CAS, L MCA angioplasty, and left EC-IC bypass. A third patient had occlusion of the right ICA and severe left ICA stenosis. In every case, acetazolamide challenge was carried out in the acute phase following presentation. All three patients developed significant prolonged worsening of neurologic deficits following the administration of acetazolamide (1 g). Patients received aggressive intravenous hydration. Two of the patients regained pre-acetazolamide neurological status within 18 hours. The third patient recovered several days after emergency left carotid artery stenting. Imaging studies (CT in 2 cases; MRI in 1) did not reveal interval haemorrhage or additional ischaemic changes in any case.ConclusionAdministration of acetazolamide has the potential to induce decline in neurological function after administration in the acute phase and may be persistent for several hours or days. A steal phenomenon is a possible mechanism. The combination of severe extracranial and intracranial vascular disease may predispose to prolonged deficits and may be a contraindication to diagnostic use of acetazolamide.DisclosuresR. Tawk: None. B. Eidelman: None. R. Hanel: None. J. Meschia: None. K. Barrett: None.
E-020 The Effectiveness and Safety of Dexmedetomidine during Coil Embolisation for Intracranial Aneurysm
Authors: Chang C , Jung Y , Choi B 
Published: July 2013

Introduction/PurposeThe general goals of anaesthetic management during endovascular procedure involve haemodynamic control to minimise the risk of aneurysm re-rupture, to protect the brain against ischaemic injury and to keep the patient motionless to optimise the quality of the images used to perform the endovascular procedure: hence, general anaesthesia with endotracheal intubation is often preferred for these procedures at most centres. But general anaesthesia is not available in all hospital and in all situations. At the authors’ institution, coil embolisation of the intracranial aneurysm is performed under monitored anaesthesia using dexmedetomidine. To determine the feasibility and safety of this approach, the author has reviewed our clinical experience.MethodsRetrospectively analysis of prospectively collected data at single neurovascular institution was performed during July 2012 to November 2012. We performed more than 50cases using this method. In these cases, we analysed 12cases, their procedure time is more than 1hour for statistical significance.To measure the haemodynamic and respiratory impact of the drug to the patients, vital signs of the patients were checked every 10 minutes throughout the procedures. Systolic blood pressure (sBP), diastolic blood pressure (dBP), mean arterial blood pressure (mABP), heart rate (HR), respiratory rate (RR) and peripheral oxygen saturation (SpO2) were recorded at each time point as follow; preoperative baseline, at anaesthesia start, after every 10 minute until the end of procedures. Depth of sedation was measured by Ramsay sedation scale and frequency of the repeated roadmap caused by the patient head movement during the endovascular procedure.ResultsAll procedures were completed without procedure related complications. Obliteration of the intracranial aneurysm was performed in all cases. With dexmedetomidine induced monitored anaesthesia, vital signs (sBP, dBP, and mABP, HH, RR and SpO2) of the patients were not changed during the procedure. Haemodynamic and respiratory parameters did not showed any statistical significance (P value > 0.05). Adequate sedation for endovascular procedure was achieved. Mean Ramsay sedation scale was 3.67 ± 1.61 (2 to 6). Repeated roadmap due to patient’s factor was occurred in only one case. The drug dose for adequate sedation for endovascular procedure was 0.65 ± 0.12 mcg/kg/hr without loading doses.ConclusionEmbolisation of the intracranial aneurysms with dexmedetomidine anaesthesia appeared to be safe and feasible. Differently with other drugs, there was no systemic side effects such as hypotensio, bradycardia and respiratory depressions. In you need endovascular surgery for intracranial aneurysm; general anaesthesia is the first choice to be selected. But local anaesthesia with dexmedetomidine should be considered as alternative, when it is not suitable .DisclosuresC. Chang: None. Y. Jung: None. B. Choi: None.
E-028 Intracranial Stenting without Angioplasty for Cerebral Aneurysms with Adjacent Vessel Stenoses
Authors: Toth G , Elgabaly M , Bain M , Hui F , Hussain M 
Published: July 2013

IntroductionIntracranial stenting is currently not routinely recommended for intracranial stenotic disease based on recent clinical trial results. However, wide-necked cerebral aneurysms with adjacent vascular stenoses may require stent placement to assist with coil embolisation. The safety and efficacy of this approach have not been well studied.ObjectiveWe report the outcomes of intracranial stent placement and coiling in patients with wide-necked intracranial aneurysms and associated vessel stenosis.MethodsReport of 2 cases with relevant neuroimaging and literature reviewResultsThe first female patient presented with dizziness and vertigo, and was found to have an unruptured wide-necked basilar apex aneurysm involving both posterior cerebral artery origins. In addition, there was significant atherosclerotic narrowing of the distal basilar artery, just proximal to the aneurysm. The second female patient initially presented with subarachnoid haemorrhage from a ruptured broad-based posterior communicating artery aneurysm, which was first coil embolised, but later showed recurrence requiring re-treatment. This patient also had moderate adjacent parent vessel stenosis. After a 5-day pretreatment with aspirin and clopidogrel, endovascular coiling was performed with Neuroform stent (Boston Scientific, Fremont, CA) assistance in both cases. The vascular reconstruction device covered the stenotic vessel segments. No balloon angioplasty was performed. We encountered no periprocedural complications. Both patents remained clinically asymptomatic with 6-month follow-up angiograms demonstrating stable aneurysm occlusion and improved vascular stenoses.ConclusionStent assisted coiling may be a feasible option for wide-necked intracranial aneurysm with associated pre-existing vascular stenoses. In our cases, Neuroform stent placement across the stenotic area was safe without in-stent stenosis, thromboembolism, ischaemia or other adverse event. These results are promising, but a larger cohort is needed to assess long-term outcome.DisclosuresG. Toth: None. M. Elgabaly: None. M. Bain: None. F. Hui: None. M. Hussain: None.
E-031 Versatile Fill Coils: Initial Experience as Framing coil for Oblong Aneurysms
Authors: Osanai T , Bain M , Hui F 
Published: July 2013

IntroductionOblong aneurysms, with dimensions of 2:1 or greater aspect ratios, are typically coiled with framing coils with helix diameter of aneurysm (l+w)/2, thus a 6 x 3 mm aneurysm might be framed with a 4–5 mm coil. The introduction of the versatile fill coil which has two separate coil elements - loops and longer wave segments - allows another approach to framing oblong or snow-man shaped aneurysms.MethodsThe endovascular database at a single institution was reviewed to assess aneurysms coiled with versatile fill coils as a framing coil yielding 3 consecutive patients in non-spherical, oblong aneurysms. The results were reviewed and demographic and outcome information collected and summarised.Results3 patients (1 man and 2 women) were treated with VFC coils, 1 with balloon assistance and 0 with stent assistance. All cases were diagnosis as ruptured aneurysm which located in Anterior communicate artery. There were no complications immediately post procedurally, with 1 case of intraprocedural catheter induced vasospasm which resolved with calcium channel blockers. Complete occlusion was achieved in all cases. There were no recurrent and re-bleeding during follow up periods.ConclusionThe VFC coil may offer an alternative to spherical framing coils in oblong aneurysms, as the coil structure offers elements that conform to the short axis diameter of the aneurysms, with wave elements that displace the loop elements, peripheralising along the aneurysm length. Further experience would be necessary to confirm these clinical impressions.DisclosuresT. Osanai: None. M. Bain: None. F. Hui: 2; C; Microvention.
E-033 Single Session, Single Pedicle Injections in the Treatment of Brain Arteriovenous Malformations
Authors: Durst C , Evans A 
Published: July 2013

Background and PurposeCure rates using traditional open surgical techniques decrease and risks increase as arteriovenous malformations (AVMs) increase in size, develop deep venous drainage, or encroach upon areas of eloquence. Using a percutaneous transluminal approach, Onyx may be used to cure AVMs in a single treatment session offering an alternative to open surgery.Materials and MethodsTwelve patients underwent Onyx embolisation of an AVM using a novel technique, termed the plug then push, in which a well-formed plug is formed around the treatment catheter prior to injecting the Onyx. The plug mitigates the risk of backflow and catheter entrapment, thereby allowing the user to inject higher volumes of Onyx at higher injection rates.All patients were followed clinically throughout the immediate post-operative course. Requests were made to return for 2 month, 12 month, and 24 month follow up imaging.ResultsUsing the plug then push technique, it was possible to inject an average of 8.8 mL of Onyx into the AVM, significantly more than using traditional techniques (p=0.049). The faster injection rate and need for only a single treatment session reduced treatment time by over 50% (p < 0.001). Angiographic cures were achieved in 83% of patients. There were three complications related to the procedure. Two resulted in permanent morbidity and one resulted in temporary dysarthria. There was a 12% recurrence rate with 1 patient demonstrating a recurrence at 24 months after initially appearing cured in follow-up.ConclusionThe plug then push technique allows for a more rapid injection of contrast due to the formation of a well controlled plug prior to treatment, mitigating the risk for backflow of Onyx and entrapment of the catheter. As such, complete obliteration of an AVM can be expected in at least 83% of cases after a single session, resulting in an approximate 50% reduction in total procedural time.Long term results from this study and the literature suggests that 6–12 months of follow-up imaging may be insufficient to declare a permanent angiographic cure. We suggest that a “cure” should not be declared until at least the 2 year follow-up demonstrates no residual or recurrent AVM.DisclosuresC. Durst: None. A. Evans: 1; C; The For the Love of Molly Foundation.
E-037 Initial Multi-Centre Experience with the Penumbra PC 400 Detachable Coil in aneurysms 10 mm or greater
Authors: Chaudry I , Frei D , Baxter B , Patel A , Huddle D , Loy D , Moyle H , Polykarpou M , Patel A , Turner R , Turk A 
Published: July 2013

BackgroundAneurysm coil technology has changed considerably since the introduction of the GDC coil. We evaluated our initial clinical experience with a novel 0.020 Penumbra PC 400 coil to determine device safety and acute performance.Materials and MethodsBetween 2/2011 and 9/2012, 143 aneurysms were coiled with Penumbra PC 400 coils at four high volume centres. Of these, 40 aneurysms had a maximum diameter of 10 mm or greater. Average aneurysm size in this cohort was 13 mm with 20% of aneurysms being ophthalmic in location, 22% other ICA (cavernous, superior hypophyseal or dorsal wall), 17% in ACOM region, 12.5% PCOM, 15% Basilar, 7.5% vertebral and 5% in the MCA. 18% of the cases were treated with balloon assisted coiling, 33% were stent assisted coiling, and 3% utilised both balloons and stents. 30% of the cases achieved an initial Raymond Scale of 1, 25% achieved a Raymond scale of 2, and 45% were Raymond Scale of 3. Half (20) of this patient cohort have angiographic follow up at the time of this abstract. Based on the same/better/worse scale there is a strong trend towards improved angiographic outcomes at 6 months and one year. Eleven had improved, 6 remained unchanged and 2 worsened, none have required retreatment. We experienced a 5% clinically significant procedural complication rate, which include an aneurysm perforation in a 21 mm right dorsal wall ICA aneurysm that presented as a grade 4 Hunt and Hess SAH who expired and a temporal lobe infarct secondary to distal coil migration during treatment of an 18 mm paraophthalmic aneurysm in a grade 4 Hunt and Hess SAH patient that expired from SAH sequellae. We continue to use the coils and accrue follow up and will update results at time of the meeting.DiscussionThe new Penumbra PC 400 coils are a unique 0.020 coil that appears to be safe and effective in treating large aneurysms.DisclosuresI. Chaudry: 2; C; Penumbra, Microvention, Covidien. D. Frei: None. B. Baxter: None. A. Patel: None. D. Huddle: None. D. Loy: None. H. Moyle: None. M. Polykarpou: None. A. Patel: None. R. Turner: None. A. Turk: 1; C; Penumbra.
First-Light Imagery from Suomi NPP VIIRS
Authors: Hillger Donald , Kopp Thomas , Lee Thomas , Lindsey Daniel , Seaman Curtis , Miller Steven , Solbrig Jeremy , Kidder Stanley , Bachmeier Scott , Jasmin Tommy , Rink Tom 
Published: July 2013

The Suomi National Polar-Orbiting Partnership (NPP) satellite was launched on 28 October 2011, heralding the next generation of operational U.S. polar-orbiting satellites. It carries the Visible– Infrared Imaging Radiometer Suite (VIIRS), a 22-band visible/infrared sensor that combines many of the best aspects of the NOAA Advanced Very High Resolution Radiometer (AVHRR), the Defense Meteorological Satellite Program (DMSP) Operational Linescan System (OLS), and the National Aeronautics and Space Administration (NASA) Moderate Resolution Imaging Spectroradiometer (MODIS) sensors. VIIRS has nearly all the capabilities of MODIS, but offers a wider swath width (3,000 versus 2,330 km) and much higher spatial resolution at swath edge. VIIRS also has a day/night band (DNB) that is sensitive to very low levels of visible light at night such as those produced by moonlight reflecting off low clouds, fog, dust, ash plumes, and snow cover. In addition, VIIRS detects light emissions from cities, ships, oil flares, and lightning flashes.
NPP crosses the equator at about 0130 and 1330 local time, with VIIRS covering the entire Earth twice daily. Future members of the Joint Polar Satellite System (JPSS) constellation will also carry VIIRS. This paper presents dramatic early examples of multispectral VIIRS imagery capabilities and demonstrates basic applications of that imagery for a wide range of operational users, such as for fire detection, monitoring ice break up in rivers, and visualizing dust plumes over bright surfaces. VIIRS imagery, both single and multiband, as well as the day/night band, is shown to exceed both requirements and expectations.
Surface Circulation Types and Daily Maximum and Minimum Temperatures in Southern La Plata Basin
Authors: Penalba Olga Clorinda , Bettolli María Laura , Krieger Pablo Andrés 
Published: July 2013

AbstractLa Plata basin is one of the most important agricultural and hydropower-producing regions in the world. Extreme climate events such as cold and heat waves and frost events have a significant socioeconomic impact. This work analyzes the influence of the surface circulation in southern South America on daily maximum temperature TMAX and daily minimum temperature TMIN in southern La Plata basin. A Z test for the comparison of mean values and a Kolmogorov–Smirnov test for the comparison of distributions of TMAX and TMIN associated with each circulation pattern were performed. Specific daily surface circulation types are found to contribute to TMAX and TMIN anomalies and to have a predominant occurrence in the development of the extreme temperature events in the region. The TMAX spatial response to the regional low-level circulation is more homogenous and extended than is the response of TMIN.