bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-034 Acute Shortening of Carotid Wallstent after Successful Carotid Artery Stenting
Authors: Nagayama T 
Published: July 2014

Carotid artery stenting (CAS) for carotid artery stenosis has become an alternative for treating patients not eligible for carotid endarterectomy (CEA). Even though the CAS is relatively simply in many cases, various complications such as distal embolization and hyperperfusion can occur. We repot a rare case of CAS using the Carotid Wallstent, which was complicated by acute shortening of the stent after successful CAS, and discuss the possible mechanisms of this complication.A 79-year-old male presented with amaurosis fugax in the left internal carotid artery (ICA) territory. Digital subtraction angiography (DSA) showed severe left ICA stenosis (NASCET criteria; 90%). CAS was performed under local anesthesia using a 10 × 24 mm Carotid Wallstent and PercuSurge GuardWire protection system. Immediate post-stent angiography showed successful stent implantation without any complication. A follow-up cervical x-ray film a half day after stenting showed stent shortening toward the proximal end, and DSA obtained 4 days later revealed residual stenosis of the distal portion of the stent. Therefore an additional CAS was done using a Precise stent.Shortening of Carotid Wallstent seemed to be induced by marked diameter mismatch between the distal and proximal ICA or the ICA and CCA, and can occur even after successful CAS. An expansion of Carotid Wallstent at the large diameter of ICA and CCA level might have caused stent shortening, which pulled the distal end of the stent downward. Therefore, short term follow-up evaluation is important to detect unexpected complications such as stent shortening.DisclosuresT. Nagayama: None.
E-053 Multi-Modality Management of Posterior Fossa Arteriovenous Malformations: Clinical and Angiographic Outcomes
Authors: Robert T , Blanc R , Ciccio G , Gilboa B , Boissonnet H , Fahed R , Redjem H , Pistocchi S , Bartolini B , Piotin M 
Published: July 2014

BackgroundInfratentorial arteriovenous malformations (AVM) are rare entities, representing only 7–15% of cerebral AVMs. The concentration of eloquent neurological systems and the high rate of bleeding presentation of AVMs in this location complicate the management of such lesions. New therapeutic options, especially in endovascular neurosurgery, have fundamentally modified the strategy and also the outcome of posterior fossa AVMs.MethodsBetween 1999 and 2013, baseline, clinical and angiographic data of cerebral AVMs were prospectively collected. We analyzed data from patients treated for a posterior fossa AVM, focusing on risk factors for bleeding, and clinical and angiographic outcomes.ResultsSixty-nine patients (mean age 34 years, male to female ratio: 2) were consecutively treated for an infratentorial AVM. Fifty-seven presented with haemorrhage, 6 with focal neurologic deficits, the 6 cases were diagnosed incidentally. The Spetzler-Martin grade was <3 in 39 (56.5%) cases. Associated aneurysms were noted in 43.5% of cases. All patients had been treated by endovascular procedures, associated with microsurgical resection in 9 patients and with stereotactic radiosurgery in 6 cases. Mean follow-up was 28.5 months, with angiographic exclusion of the AVM in 72.5% of cases; 21.7% of patients presented a modified Rankin Score ≥3 at follow-up.ConclusionsEndovascular embolization is a valid and secure approach for posterior fossa AVMs although a large number of sessions is necessary to achieve complete obliteration. Multi-disciplinary discussion and management is crucial to obtain the best cure rate without increasing procedural risks.DisclosuresT. Robert: None. R. Blanc: None. G. Ciccio: None. B. Gilboa: None. H. Boissonnet: None. R. Fahed: None. H. Redjem: None. S. Pistocchi: None. B. Bartolini: None. M. Piotin: None.
E-054 Angiographic Factors Influencing the Success of Endovascular Treatment of Arteriovenous Malformations involving the Corpus Callosum
Authors: Robert T , Blanc R , Gilboa B , Ciccio G , Fahed R , Redjem H , Pistocchi S , Bartolini B , Piotin M 
Published: July 2014

ObjectArteriovenous malformations (AVM) of the corpus callosum were rare lesions, accounting for 9–11% of brain AVMs. Microsurgical resection of such lesions remained difficult regarding deep location and possible neuropsychological disasters of extended callosal resection. The introduction of endovascular and radiation therapies fundamentally changed the outcome of these lesions.MethodsSince 1995, clinical and angiographic data of cerebral AVMs were prospectively collected. We reviewed data from patients treated for an AVM of the corpus callosum and discussed factors influencing the endovascular approach of such lesions.ResultsThirty-eight patients (mean age: 31 year) were consecutively treated by endovascular techniques. 78.9% (30 cases) presented with intracranial haemorrhage. 15 AVMs (39.5%) were anterior, 18 (47.4%) posterior and 5 (13.1%) holocallosal. The Spetzler-Martin grade was I in 2 cases (5.2%), II in 20 (52.6%), III in 9 (23.7%), IV in 6 (15.8%) and V in 1 case (2.6%). The nidus was compact in 19 cases (50%), diffuse in 13 (34.2%) and multifocal in 6 (15.8%). Both anterior and posterior circulation branches fed 14 nidi (36.8%). The venous drainage was superficial in 3 cases (7.9%), deep in 28 (73.7%) and both in 7 (18.4%). 104 sessions have been performed with a procedural complication rate of 6.7%. The mean follow-up was 43.6 months with a last mRS <3 in 33 cases (86.8%). 22 patients (57.9%) have been totally cured. Univariate analysis of factors influencing the success of endovascular treatment showed that Spetzler-Martin grade ≥3 (p = 0.046), nidus >30 mm (p = 0.02), extension in eloquent area (p = 0.03) and holocallosal type (p0.005) significantly diminish chances to cure the AVM.ConclusionsAVMs of the corpus callosum seems to be difficult to treat with endovascular therapy alone. The goal of embolization should be the prevention of (re) bleeding and the decrease of nidus size. When endovascular treatment could not achieve to the complete cure of the AVM, associated radiotherapy permitted to increase the occlusion rate.DisclosuresT. 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-063 Physicians Use Perfusion Imaging to Aid in Diagnosis and Treatment Decisions for Acute Ischemic Stroke
Authors: Seifert K , Wiener J , DeOrchis D 
Published: July 2014

BackgroundRecently, perfusion imaging has been utilised to provide visualization of at risk ischemic tissue that would benefit from revascularization treatment; however, current research differs in recommendations on the use of perfusion. The purpose of our study was to evaluate whether perfusion imaging helped guide diagnosis and treatment of ischemic strokes.Methods and materialsWe conducted a retrospective review for patients who received perfusion imaging and/or treatment for ischemic stroke over a three-year period. We reviewed the progression of diagnosis, treatment or lack of, complications of treatment, and whether the imaging played a role in the treatment plan.ResultsThe majority of patients in this study had treatment that was influenced by perfusion imaging. This was most evident in our population of patients that received intra-arterial therapy as 95% of these patients received treatment based on the results of imaging. There was an impact in the decision to not treat patients who had completed strokes on perfusion imaging, preventing unnecessary treatment and complications. In addition, our perfusion imaged patients were found to have a significantly longer time to treat than those that did not receive imaging, extending beyond the three-hour treatment window with an average of 4.88 h without an increased risk of complications or decrease in clinical outcome.ConclusionPerfusion imaging can be used in the real world setting as a tool to guide patient diagnosis and treatment, to select patients with salvageable tissue to receive intra-arterial treatment outside the standard intravenous time window.DisclosuresK. Seifert: None. J. Wiener: None. D. DeOrchis: None.
E-064 Safety and Efficacy of Balloon-Assisted Coiling of Intracranial Aneurysms: A Single-Center Study
Authors: Ramakrishnan V , Quadri S , Sodhi A , Cortez V , Taqi M 
Published: July 2014

ObjectiveBalloon-assisted coil embolization has become an important adjunct in the endovascular treatment of intracranial aneurysms, particularly those with challenging anatomy. The need for anti-platelet agents when deploying intracranial stents, which could lead to increased morbidity and mortality in patients with ruptured aneurysm, has made the use of balloon-assisted coil embolization (BACE) a more prevalent approach in the last several years for subarachnoid haemorrhage. We evaluated the safety and efficacy of balloon remodeling at our institute.MethodsWe performed a retrospective review of all patients who underwent endovascular coiling of aneurysms from June 2012 to February 2014.ResultsA total of 81 procedures were performed on 73 patients and 74 aneurysms were treated at our institution with endovascular techniques. 45 of 74 (60.81%) were ruptured aneurysms and venticulostomy was required in 31 (68.8%) of these patients. Balloon remodeling was used in 44 of 74(59.4%) of cases. More than 1 aneurysm were treated in the same procedure in 7 cases. 4 aneurysms were treated in 2 stages while 1 aneurysm required 3 stages for treatment. The following adverse events occurred: Thrombus formation 5/44 (11.3%); Vessel perforation from balloon 0/44 (0%); Perforation by coil occurred in 5/44 (11.3%) of cases. Dissection 0/44 (0%) and stroke related to thrombus formation 0/44 (0%). 4 out of 5 thrombi were formed in ruptured aneurysms. Balloon inflation time ranged from 1–5 min. Balloon inflation time did not correlate to thrombus formation. Neck diameters treated with balloons measured from 1.5 mm to 7.83 mm.ConclusionsIn our single-center study, balloon-assisted coiling was not associated with serious complications. Minimal intra-operative thrombi which were formed resolved with almost no adverse events in patient. Further studies will need to be performed on long term outcomes of these patients, however, balloon-assisted coiling has emerged as an important adjunct in the endovascular treatment of aneurysms.DisclosuresV. Ramakrishnan: None. S. Quadri: None. A. Sodhi: None. V. Cortez: None. M. Taqi: None.
E-065 Clinical Treatment Result of Carotid Artery Stenting in Japan: Comparison of Periprocedural Ischemic Complication by Embolic Protection Devices
Authors: Takayama K , Myouchin K , Wada T , Nakagawa H , Kichikawa K , Kurokawa S 
Published: July 2014

Carotid artery stenting (CAS) was approved in Japan in October 2007. Since then, several embolic protection devices (EPD) and stents for CAS have become available.We investigated the clinical treatment results and periprocedural ischemic complications of CAS by using a standard procedure.We retrospectively analyzed 312 patients with 329 carotid artery stenoses (272 men; age 39–97 years [mean 73.7 years]; symptomatic stenosis, 144 lesions; mean stenosis rate, 82.1%) who underwent CAS from October 2007 to March 2014. The technical success rate, periprocedural ipsilateral ischemic stroke, and incidence of ischemic lesions within 48 h after CAS with EPD were assessed using diffusion weighted images (DWIs).All cases of CAS were successful. Among nine patients (2.7%) who suffered a stroke, a major stroke occurred in one patient (0.3%) and minor strokes in eight patients (2.4%). The EPDs and stents used were as follows: Angioguard XP/RX(AG), 141; Filterwire EZ (FW), 128; MoMa Ultra (MU), 52; Spider FX, 2; Percusurge, 2; Precise (PS), 215; Carotid Wallstent (CWS), 97; Protégé (PT),14; PS and CWS, 2; PS and PT, 1. Over 50 cases of stroke and new ischemic lesions by EPD were observed in AG, 2.8% (4/141) and 33.1% (46/139); FW, 2.3% (3/128) and 22.0% (28/127); and MU, 3.8% (2/52) and 41.1% (21/51), respectively.The CAS by the standard procedure showed very good clinical treatment results. The incidence of ischemic lesions on DWI was much lower in FW than in the other EPDs.DisclosuresK. Takayama: None. K. Myouchin: None. T. Wada: None. H. Nakagawa: None. K. Kichikawa: None. S. Kurokawa: None.
E-067 Balloon assisted Pre-operative Embolization of Hypervascular Metastatic Lesions to the Spine
Authors: Jagadeesan B , Mortazavi S , Moen S , Grande A , Tummala R 
Published: July 2014

IntroductionIt is common to perform pre-operative embolization of metastatic lesions to the spine from hyper-vascular tumors. Typically, a microcatheter is navigated into a prominent arterial feeder to the tumor arising from a segmental artery or bronchial artery. Thereafter, particles or liquid embolic agents are injected into the tumor through the microcatheter, while taking care to avoid reflux into the proximal segmental artery or the aorta. However, occasionally, there may be a diffuse network of small arterial feeders arising from the segmental artery, which supply the tumor. None of these small arteries maybe amenable to selective catheterization, and embolization may be challenging due to the risk of reflux of embolic agent into the parent artery or aorta. Herein, we report our experience with embolising such metastatic lesions by injecting particles through a dual lumen balloon microcatheter positioned within the main segmental artery and using the inflated balloon to prevent reflux into the aorta.Materials and methodsWe performed pre-operative embolization for hyper vascular vertebral metastases (two thoracic spine and 2 lumbar vertebrae) in a series of 3 patients (2 male and 1 female, mean age 53) with metastatic renal cell carcinoma at our institution using the 4 × 10 mm Sceptre C balloon microcatheter. In all patients, after ensuring that there was no radiculomedullary artery arising from the segmental artery supplying the tumor feeders, a 4 × 10 mm Sceptre C balloon microcatheter was navigated into the proximal aspect of the artery. The balloon was then inflated such that there was a tight seal across the origin of the artery from the aorta and embolization of the tumor was carried out with 150–300 microns PVA particles. Intermittently, the balloon was slowly deflated and DSA was carried out to assess changes in the tumor “blush”. Embolization was carried out until there was elimination of the tumor blush.ResultsThe Sceptre C balloon microcatheter could be successfully navigated into the parent segmental vessel and inflated proximally across the origin of the vessel in all patients. Subsequent particle embolization resulted in complete elimination of the tumor “blush” in the vertebral body in every instance. There were no adverse events such as segmental arterial dissection, balloon rupture or reflux of particles into the aorta in any patient.ConclusionPre-operative embolization of hypervascular spinal mestastatic lesions can be safely carried out using a balloon-assisted technique with a dual lumen balloon microcatheter when traditional selective catheterization of feeder vessels is not feasible.DisclosuresB. Jagadeesan: None. S. Mortazavi: None. S. Moen: None. A. Grande: 2; C; Covidien, Integra. R. Tummala: 2; C; Lake Regional.
E-069 Validation of a New Modified Capillary Index Score Angiographic Real Time Assessment of Dead vs Salvable Tissue
Authors: Teleb M , Noufal M , Sattar A , Wazni W , Issa M , Asif K , Gheith A , Castonguay A , Zaidat O 
Published: July 2014

BackgroundThe original capillary index score publication only included patients that had full digital subtraction angiograms (DSA) before stroke intervention. This CIS was a single center publication with no external validation. Many centers do not perform a full DSA to assess all collaterals before intervention.HypothesisA modified capillary index score (mCIS) using only the ICA injection can predict outcome in MCA occlusions (only MCA occlusions included).ObjectiveValidate the utility and use of a modified capillary index score (mCIS) to assess outcomes and improvement in acute stroke patients.MethodsmCIS was assessed on all consecutive patients with an MCA occlusion with complete database information. NIHSS, recanalization (mTICI), and mRS before and after treatment were assessed. mCIS of 2–3 was considered favorable as per original publication. Correlation between favorable CIS, NIHSS improvement, and mRS (0–3 good) were assessed.Results33 patients with MCA occlusion with complete data sets where assessed. 63.6% (21/33) had a favorable mCIS (2–3) and 36.4% had a poor mCIS(0–1). Recanalization of TICI 2b or greater was achieved in 42.9% (9/21) of patients with favorable mCIS and 58.3% (7/12) of patients with poor mCIS. Of those with favorable mCIS 28.6% (6/21) had a good mRS of ≤3 at discharge vs those with poor mCIS while those with a poor mCIS 33.3% had a good mRS at discharge. However, mortality was lower in favorable mCIS vs. poor mCIS (9.5 vs. 33.35, p = 0.09).ConclusionsA modified CIS is did not predict the functional outcome but may be predictor of mortality. Small sample size, lack of long-term follow up, or the lower rate of recanalization of those with favorable mCIS could have contributed to the negative outcome. A prospective or larger study with long term follow up is needed for validation.ReferencesAl-Ali F, Jefferson A, Barrow T,et al. The capillary index score: rethinking the acute ischemic stroke treatment algorithm. Results from the Borgess Medical Center Acute Ischemic Stroke Registry. J Neurointerv Surg.2013;5(2):139–143. doi:10.1136/neurintsurg-2011-010146Capillary Index Score, Baseline Characteristics and OutcomesFavorable mCIS Unfavorable mCIS P ValueBaseline NIHSS 14 + /-6.9 18.3 + /-3.9 0.051Age 64.3 + /-16.6 68.8 + /-4.9 0.453Good Recanalization (2b-3) 42.9% (9/21) 58.3% (7/12) 0.391NIHSS at Discharge 10.8 + /-7.5 15 + /-2.5 0.099NIHSS at Discharge in TICI 2b and higher 5.8 + /-4.2 13.4 + /-13.7 0.067Mortality 2/21 (9.5%) 4/12 (33.33%) 0.093Good Outcome (mRS < = 3) 28.6% (6/21) 33.33% (4/12) 0.775Good Outcome in TICI2b or higher12 mRS < = 3) 5/9 (55.6%) 4/7 (57.1%) 0.0949DisclosuresM. Teleb: None. M. Noufal: None. A. Sattar: None. W. Wazni: None. M. Issa: None. K. Asif: None. A. Gheith: None. A. Castonguay: None. O. Zaidat: 2; C; Penumbra, Stryker, Covidie. 3; C; Penumbra, Stryker, Covidien.
E-070 Acute Recanalization with Stenting for Wake-up Stroke
Authors: Sung S , Lee T 
Published: July 2014

BackgroundApproximately 16% to 28% of acute ischemic stroke patients have symptoms on awakening. Because of unclear time of symptom onset, these patients are ineligible for standard intravenous thrombolysis. Some of these patients may be benefit from emergent endovascular recanalization with stenting. The purpose of this study was to evaluate the feasibility and safety of emergent endovascular recanalization for wake-up stroke (WUS).MethodsWe reviewed 10 patients with WUS and an occlusion in carotid and middle cerebral artery who were treated with stenting. We analyzed clinical and angiographic outcomes. Recanalization was evaluated by the Thrombolysis in Cerebral Infarction score. Clinical outcome was assessed at 90 days by the modified Rankin Scale.ResultsThe median NIHSS score on admission was 19 points (range 8–24). The median time from stroke symptom recognition to arrival at emergency department was 144 min (range 57–230 min). The median time from stroke symptom recognition to recanalization was 312 min (range 227–344 min). The median time from last seen normal to recanalization was 11 h 23 min (range 495–830 min). Occlusion sites were supraclinoid ICA in 2 (all: left), proximal ICA in 3 (left: 2, right: 1) and M1 of MCA in 5 patients (left: 2, right: 3). Successful recanalization was achieved in all patients. A small subarachnoid haemorrhage occurred in 1 patient during intervention. No symptomatic ICH occurred in any patients. Neurologic improvements in the NIHSS score (median 9, range 4–17) at 7 days after stenting achieved in 7 patients. At 90 days, an mRS of ≤2 was achieved in 2 patients (20%). One patient died within hospital stay due to sepsis.ConclusionEmergent stenting can be feasible and possibly safe for achieving successful recanalization and improving on the NIHSS in patients with WUS. However, clinical outcome was still not satisfactory.DisclosuresS. Sung: None. T. Lee: None.
O-016 Development and Validation of an Endovascular Chemotherapy Filter Device for Removing High-Dose Doxorubicin from the Blood:In VivoPorcine Study
Authors: Patel A , Chin A , Yang J , Thorne B , Saeed M , Wilson M , Hetts S 
Published: July 2014

PurposeA novel disposable endovascular chemotherapy filter (CF) device was developed to remove excess doxorubicin (Dox) from the blood during intra-arterial chemotherapy delivery to prevent systemic toxicities. Previous proof-of-concept established the capacity of the filter to bind Dox in swine serum in vitro. In this study, CF navigation, deployment and in vivo Dox binding was evaluated in the porcine inferior vena cava (IVC).Materials and methodsAn 18 Fr CF device was constructed with an ion-exchange membrane attached to an expandable 28 mm diameter Nitinol frame. Under X-ray fluoroscopy and contrast venography, the CF was percutaneously introduced via the internal jugular vein and deployed in the porcine infrarenal IVC. 50 mg of Dox (2 mg/ml) was injected over 10 min in the IVC below the CF device. Venous catheters with tips proximal and distal to the CF device in the infrarenal IVC obtained pressures and blood samples for Dox concentrations over 90 min across the CF device membrane.ResultsThe CF device was successfully introduced and deployed in the infrarenal IVC in vivo. Visualization under X-ray fluoroscopy verified the proper placement and mechanical expansion of the Nitinol framework. In a 90 min study, the device was biocompatible, not leading to hemodynamic disturbances: pressure measurements taken throughout the experiment yielded a max gradient of 17 mmHg across the CF membrane. Venography demonstrated non-flow-limiting thrombus associated with the CF device after 90 min of deployment (swine were not heparinized). Significant Dox binding was noted with an 85%, 74%, and 83% decrease in relative pre- versus post-filter Dox concentrations at times 3, 10, and 30 min, respectively after Dox injection.Conclusion:We developed a biocompatible CF device that can be safely introduced, deployed, and removed from the IVC in vivo. The CF device demonstrated significant Dox binding, and could serve as a platform technology in drug therapy to allow for higher regional doses of drug while limiting systemic toxicity. In future in vivo experiments, animals or the CF device itself may be heparinized in order to prevent thrombosis. When fully developed, indications for this device could include head and neck cancer, with the device deployed in the superior vena cava or internal jugular veins during selective IA chemotherapy.DisclosuresA. Patel: 1; C; NIH-NCI. 4; C; ChemoFilter. A. Chin: 1; C; NIH-NCI. 4; C; ChemoFilter. J. Yang: None. B. Thorne: None. M. Saeed: None. M. Wilson: 1; C; NIH-NIBIB, NIH-NCI. 4; C; ChemoFilter. S. Hetts: 1; C; NIH-NIBIB, NIH-NCI, Siemens, Covidien. 2; C; Stryker, Penumbra, Silk Road Medical, Medina Medical. 4; C; ChemoFilter, Medina Medical, DriftCoast.