bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-001 TARGET Intracranial Aneurysm Coiling Prospective Multicenter Registry: Initial Periprocedural Results in 120 Patients
Authors: Zaidat O , Castonguay A , Puri A , Rai A , Badruddin A , Mack W , Alshekklee A , Shah Q , Hussain S , Kabbani M , Bulsara K , Taqi M , Janardhan V 
Published: July 2014

Background and purposeTo describe the periprocedural results of the TARGET Registry, an on-going, prospective, non-randomised, multicenter, real-world study of patients with ruptured or unruptured intracranial aneurysms that are embolised with the new generation TARGET Coils. In particular, the aneurysm that were coiled with 100% 360 complex coils only were compared to the aneurysm that were coiled with mixed 360 and helical coil or helical coils only.MethodsPatients withde novountreated ruptured or unruptured intracranial aneurysms were embolised with either TARGET 360° or Helical coils in 13 US centers. The primary outcome, aneurysm packing density (PD), was assessed at immediate post-procedure. Analysis was by per protocol. The secondary outcomes were modified Rankin’s Scale (mRS) at discharge and the influence of use of 100% 360 coils on clinical and angiographic outcomes. JMP statistical software was used for analysis.Results120 patients enrolled to date were eligible for this per protocol analysis. 51 (42.5%) patients with ruptured and 69 (57.5%) with unruptured aneurysms were treated. Mean age was 58.1 ± 13.04 years; 75.6% female, 73.3% white. TARGET 360° coils was used in 60.5%, mixed 360° and Helical Coils in 35.1%, and TARGET Helical Coils in 4.4% of the cases. Immediate complete occlusion rate was seen in 84.4% of the cases. Packing density was the main predictor of complete occlusion (mean PD 28.7 ± 18.1 in those with complete occlusion vs. 20 ± 12, p-value 0.005). Mean PD was 25.4 ± 16.3%. Multivariate analysis showed maximum aneurysm size (p value 0.0001), and use of stent (p value 0.02) to be independent predictors of PD. In-hospital mortality was 0.8% (1/120) and discharge good outcome (mRS 0–2) was seen in 110/120 (91.7%). Poor outcome occurred in 13.7% of the ruptured aneurysm and 4.4% of the unruptured aneurysms. Predictors of discharge outcome included age, rupture presentation, aneurysm neck size, and occlusion grade.ConclusionIn this prospective and core lab adjudicated multicenter Target aneurysm registry, the mean PD was 25.4 ± 16.3% and was the main predictor of complete aneurysm occlusion. Poor outcome was 4.4% in the unruptured aneurysm and 13.7% in the ruptured aneurysms. Predictor of outcome at discharge included age, rupture status, aneurysm occlusion, and aneurysm neck size.DisclosuresO. Zaidat: None. A. Castonguay: None. A. Puri: None. A. Rai: None. A. Badruddin: None. W. Mack: None. A. Alshekklee: None. Q. Shah: None. S. Hussain: None. M. Kabbani: None. K. Bulsara: None. M. Taqi: None. V. Janardhan: None.
E-003 Aneurysm Re-treatments Following Recurrences After Initial Use of the Pipeline Embolization Device
Authors: Park M , Nanaszko M , Sanborn M , Moon K , McDougall C , Albuquerque F 
Published: July 2014

IntroductionAlthough the Pipeline Embolization Device (PED, eV3 Neurovascular, Irvine, California) has provided the field of neuro-interventional surgery with a significant leap forward in the treatment of cerebral aneurysms, treatment failures still exist with this new platform. We sought to examine our experience with re-treatments of cerebral aneurysms after initial treatment with the PED.Materials and methodsWe retrospectively examined our prospectively maintained endovascular neurosurgical database for cerebral aneurysm treatment failures using the PED from May 2011 to the present time. Nine patients (1 male, 8 female; Age range 28–83 yrs, average age 54.4 yrs, SD 17.5 yrs) treated for nine aneurysms (Average size 17.7 mm, SD 11.9 mm) out of 137 total patients treated with PED were identified during our study period (6.6% re-treatment rate, 9/137).ResultsOf the nine re-treatments, six were due to persistent filling of the aneurysm, while three were re-treated due to PED contraction/migration at an average time interval of 6.9 months (SD 3.7 months). Following the initial treatment and at the time of re-treatment, all aneurysms had a Raymond 3 occlusion. Despite this, the angiographic appearance of the aneurysms at the time of re-treatment remained the same in 2, better in 6, and worse in 1. At the last follow-up, two aneurysms had a Raymond 1 occlusion, three aneurysms had a Raymond 2 occlusion, and four aneurysms had a Raymond 3 occlusion. Eight aneurysms had better angiographic outcomes versus one aneurysm with a worse angiographic outcome since the re-treatment.ConclusionWhile there is a low rate of treatment failure following use of the PED, re-treatments can be performed in a safe and effective manner and lead to continued angiographic improvements on long term follow-up.DisclosuresM. Park: None. M. Nanaszko: None. M. Sanborn: None. K. Moon: None. C. McDougall: None. F. Albuquerque: None.
E-005 Short-term Outcomes of Acute Ischemic Stroke Patients with MCA/ICA Occlusion Excluded for Intra-arterial Reperfusion Therapy
Authors: Honarmand A , Beck R , Soltanolkotabi M , Ansari S , Shaibani A , Daruwalla V , Hurley M 
Published: July 2014

IntroductionLarge-vessel occlusions account for 45% of patients with acute ischemic stroke (AIS) presenting to the emergency departments in the United States. Many of these patients may not be eligible candidates for intravenous tPA therapy; however, they may benefit from receiving intra-arterial therapy (IAT). Optimal patient selection plays a pivotal role in identification of those AIS patients who may benefit from IAT. However, no method has been introduced as the gold standard for patient selection among neurointerventionalists in the clinical practice. Therefore, many of the stroke patients with large vessel occlusion presenting in the acute setting do not receive IAT.We aimed to review the short-term outcome of AIS patients with large vessel occlusion who were not selected for IAT.MethodsWe retrospectively reviewed consecutive AIS patients with National Institute of Health Stroke Scale (NIHSS) score of more than 8 and CTA/MRA verified MCA/ICA occlusion who did not receive endovascular thrombectomy/thrombolysis treatment. Data were collected on demographics, initial NIHSS score, the cause for not being eligible for endovascular intervention, and mortality rate during the first 30 days. Eligibility for undergoing IA thrombectomy/thrombolysis treatment based on CT/MR perfusion imaging profiles was defined as CBV/DWI infarct core 20% infarct core.ResultsThirty one AIS patients (19 F/12 M; mean age of 78.1(32–93; SD: ±13.44 years) were studied. Mean and median baseline NIHSS score were 20.06 (8–40; SD: ± 8.25) and 19, respectively. Mortality in the first 30 days was 38.7% (12/31) and 6 patients (20%) were referred to hospice. Among fourteen patients who did not undergo endovascular thrombectomy/thrombolysis reperfusion therapy due to the unfavorable perfusion profile, six patients expired and 4 patients were referred to the hospice, in the first 30 days. Seventeen patients were not intervened due to improvement in NIHSS score following receiving intravenous tPA, advanced age, severely high NIHSS score, and high risk clinical profile for intervention. Among these patients, six patients expired and two patients were referred to hospice.ConclusionIn this cohort of patients, we observed relatively high mortality rate and poor short-term clinical outcomes in AIS patients with large vessel occlusion who were not selected for IAT. Patients excluded from receiving IAT using imaging-based methods, generally had worse outcomes compared with those patients who were selected based on clinical evaluation. Efforts should be made to develop a standard and accurate patient selection method for identification of the optimum number of AIS patients with large vessel occlusion who may benefit from IAT.DisclosuresA. Honarmand: None. R. Beck: None. M. Soltanolkotabi: None. S. Ansari: None. A. Shaibani: None. V. Daruwalla: None. M. Hurley: None.
E-011 TICI Quantified: Automated Cerebral Revascularization Grading in Acute Ischemic Stroke
Authors: Sattar A , Asif K , Teleb M , Castonguay A , Issa M , Zaidat O 
Published: July 2014

IntroductionCerebral angiographic revascularization grading is the primary method for measuring the angiographic success of acute ischemic stroke (AIS) endovascular therapy and is one of the strongest predictors for clinical outcome. Of the many reported scales, the modified Treatment in Cerebral Ischemia (mTICI) scale is the preferred grading scale for assessment of revascularization. Currently, mTICI grading is based on visual crude estimations by the operator, which may introduce error and bias in to the evaluation. Here, we present an update on our on-going study to automatize mTICI and provide a more accurate and precise grading tool: Quantified TICI (qTICI).MethodsPhase one of the project is to develop a database of 15–30 patients with an aplastic/hypoplastic anterior cerebral artery (ACA) in order to establish the standard average and predicted 100% qTICI for the isolated middle cerebral artery (MCA) territory. To map the MCA territory, a retrospective review of patients between the ages of 18–85 was performed from our Digital Subtraction Angiography (DSA) database at the Medical College of Wisconsin. All consecutive cases with aplastic/hypoplastic ACA (to minimise contaminating blood flow from the ACA territory) are included in this study. Existing Siemens software is currently in use to estimate the territory of normal capillary blush and establish normal blood flow values in this database.ResultsWe have identified 19 consecutive patients with aplastic/hypoplastic ACA between the ages of 18–85, from our DSA database of over 3000 cases. Nine patients had aplastic A1 and 10 had hypoplastic A1 segments of the ACA. Once normal capillary blush of the MCA territory has been established and automatized, we will use those normalised values per age to compare the capillary blush and blood flow of the pathological cases- a cohort of 20–25 patients who have stroke secondary to MCA occlusion. Values of qTICI will be compared and validated using standard visual estimation of mTICI. Clinical correlation of qTICI with outcome will also be performed. The goal is to establish software that will accurately grade mTICI on a continuous scale rather than using the current crude visual estimation with wide range 4 strata, which will eliminate the operator dependent bias and increase the precision and accuracy of the revascularization grading.ConclusionThe qTICI Grading Software once developed will have the potential to revolutionise the way clinicians and interventionalists grade revascularization post AIS endovascular therapy. The clinical implications of establishing automatized and quantified revascularization scale is critical in improving treatment safety and efficacy.DisclosuresA. Sattar: None. K. Asif: None. M. Teleb: None. A. Castonguay: None. M. Issa: None. O. Zaidat: None.
E-013 Endovascular Management of Pseudoaneurysms Secondary to External Ventricular Drain Placement: Single Center Experience
Authors: Choudhri O , Gupta M , Heit J , Feroze A , Do H 
Published: July 2014

IntroductionPlacement of external ventricular drains is a common, life-saving neurosurgical procedure indicated across a variety of settings. While advances have made the procedure quite safe, the potential for iatrogenic morbidity and mortality continues. Herein, we document our experience with the endovascular management of three pseudoaneurysms associated with EVD placement.Patients and methodsWe performed a retrospective analysis to identify all EVDs placed from 2008 through 2013 at our institution,. In instances of EVD-associated cerebrovascular injury, all admission and subsequent radiographic studies were reviewed, including cerebral angiograms and computed tomography (CT) scans. Angiograms were reviewed to record the extent of vascular injury and angiographic outcomes after treatment.ResultsOne female and two male patients (40–75 years) were found to have developed vascular injuries associated with EVD placement. Three pseudoaneurysms, namely of the posterior communicating artery (PCOM), pericallosal artery branch and the middle meningeal artery, were treated by coil and/or glue embolization.ConclusionsAlthough EVD-associated cerebrovascular injury remains a rare phenomenon, such procedures are not entirely benign. Endovascular repair for such lesions proves a viable, effective option.Abbreviationsarteriovenous fistula (AVF), computed tomography (CT), external ventricular drain (EVD), posterior communicating artery (PCOM), posterior cerebral artery (PCA)DisclosuresO. Choudhri: None. M. Gupta: None. J. Heit: None. A. Feroze: None. H. Do: None.
E-014 Changes in Posterior Circulation Arterial Flows after Revascularization Surgery in Moyamoya Disease: A Quantitative MRI Study
Authors: Navarro R , Feroze A , Choudhri O , Lober R , Khan N , Steinberg G 
Published: July 2014

Background and purposeMoyamoya disease and syndrome are well known to affect the anterior cerebral circulation by progressive steno-occlusive disease of the supraclinoid internal carotid arteries. Less attention has been paid to changes in posterior arterial circulation hemodynamics in this condition. We sought to better understand the latter using a relatively novel noninvasive imaging technique, quantitative magnetic resonance angiography (qMRA). We assessed the diagnostic utility of qMRA for posterior arterial circulation flows before and after surgical revascularization.Materials and methodsThis retrospective review included patients who met the following inclusion criteria: (1) diagnosis of moyamoya disease or syndrome with revascularization surgery at Stanford University between September 2008 and March 2012; (2) preoperative and postoperative qMRA scans on record within a two-year time frame; and (3) high-quality qMRA images without motion artefact. Cerebral blood-vessel flow was quantified after non-contrast magnetic resonance imaging (MRI) through the use of a commercially available software tool, non-invasive optimal vessel analysis (NOVA, VasSol, Chicago, USA).ResultsA total of 191 patients underwent 281 surgeries during this period of time. Of these, a cohort of 64 patients (78% female, mean age 38.5 years, 55% unilateral disease) had pre- and post-operative qMRA studies. Preoperative arterial flows in the posterior circulation were markedly elevated compared to normal controls. These flows significantly decreased after revascularization (94% direct STA–MCA bypass) with right PCA flow 145 mL/min pre-surgery vs. 123 mL/min post-surgery (p = 0.005, n = 51) and basilar artery flow 264 mL/min pre-surgery vs. 222 mL/min post-surgery (p < 0.001, n = 58). A notable decrease in flow rates was also appreciated within the left PCA distribution, albeit not to a statistically significant degree (p = 0.121, n = 53). No statistically significant changes were noted in posterior communicating artery flows.ConclusionsQuantitative MRA shows that posterior circulation arterial flows are markedly increased in patients with moyamoya disease. After revascularization, there is an overall decrease in these flows that is significant in the basilar artery and right posterior cerebral artery. Further use of qMRA might be warranted to better understand moyamoya hemodynamics before and after surgery.AbbreviationsMMD = moyamoya disease NOVA = noninvasive optimal vessel analysis; qMRA = quantitative magnetic resonance angiographyKeywordsmoyamoya disease, quantitative magnetic resonance angiography, cerebral blood flowDisclosuresR. Navarro: None. A. Feroze: None. O. Choudhri: None. R. Lober: None. N. Khan: None. G. Steinberg: None.
E-017 Cerebrovascular Decision Making: Professional and Personal Preferences
Authors: Tanweer O , Wilson T , Kalhorn S , Golfinos J , Huang P , Kondziolka D 
Published: July 2014

IntroductionIt is known that physicians sometimes recommend treatment that, in a similar clinical scenario, they might not choose for themselves. We sought to understand this dynamic across cerebrovascular practice and examine how neurosurgeons value the procedures they offer.MethodsWe conducted an online survey sent to a large cohort of neurosurgeons in May 2013. Respondents were randomised to answer either as the surgeon or as the patient. The questions involved patients presenting with 1) an epidural hematoma (control), 2) un-ruptured anterior communicating artery aneurysm, 3) incidentally found right temporal AVM, 4) spontaneous intracranial and intraventricular haemorrhage in deep structure. Data on practice parameters and experience levels was also collected.ResultsWe obtained 534 survey responses, 279 responding as the “neurosurgeon”, and 255 as the “patient,” with a response rate of 19.7%. Demographics amongst the two groups of survey takers was similar. There was no difference in the management of an epidural hematoma, as expected. For the unruptured aneurysm, the rates of opting for treatment was similar amongst respondees. However within the treatment group there was a trend for survey takers to more often chose coiling for themselves and clipping for patients (p = 0.056). Surgeons, however, with a greater than 30% open-cerebrovascular practice had less of a tendency to do so. For arteriovenous malformation management, there was no statistical difference between choosing treatment or conservative management. However, amongst the respondees who chose treatment, more respondees chose resection/embolization for their patient but radiosurgery for self (p = 0.001). In a case of a large spontaneous intracranial and intraventricular haemorrhage neurosurgeons were more likely to place a ventricular drain in a patient than himself or herself. Neurosurgeons in practice more than 10 years since residency were more likely to recommend against interventions for aneurysms, AVMs or intracranial haemorrhage.ConclusionsIn the majority of cases altering the role of the surgeon did not change the decision to pursue treatment or conservative treatment. In certain clinical scenarios, however, neurosurgeons choose treatment options for themselves that are different than what they would choose for their patients. For the management of an arteriovenous malformations, intracranial aneurysms, and hypertensive haemorrhage, responses favored less invasive interventions when the surgeon was the patient. These findings are likely a result of cognitive biases, previous training, experience, areas of expertise, and personal values.DisclosuresO. Tanweer: None. T. Wilson: None. S. Kalhorn: None. J. Golfinos: None. P. Huang: None. D. Kondziolka: None.
E-018 Flow-Diversion for Complex Middle Cerebral Artery Aneurysms
Authors: Zanaty M , Chalouhi N , Tjoumakaris S , Gonzalez L , Rosenwasser R , Jabbour P 
Published: July 2014

ObjectiveTo evaluate the safety and efficacy of flow-diversion for treatment of large and complex middle cerebral artery (MCA) aneurysmsMethodWe conducted a retrospective review of the clinical charts of all patients who underwent PED placement for aneurysm at our institution from October 2010 to October 2013. We included 10 patients of which 5 had large MCA aneurysms and 3 had giant ones. Fusiform unruptured aneurysms represented 7 of all 10 aneurysm. Angiographic and clinical follow-up were available for all patients mostly between 7 and 12 months.ResultsWe had no technical complications, no periprocedural morbidity and mortality. On follow-up we had no hemorrhagic complication, no aneurysm rupture and only one clinically significant thromboembolic event in a patient who discontinued antiplatelet therapy against medical advice. One patient had completely occluded his diseased vessel but remained asymptomatic. The overall complication rate is 3/10. On follow-up complete occlusion occurred in 7 patients (7/9).ConclusionPED treatment for large, giant and bifurcation MCA aneurysms was feasible, with satisfying complete-occlusion rate, no mortality and reasonable morbidity rate.DisclosuresM. Zanaty: None. N. Chalouhi: None. S. Tjoumakaris: None. L. Gonzalez: None. R. Rosenwasser: None. P. Jabbour: None.
E-019 Flow Diversion in the Setting of Subarachnoid Haemorrhage
Authors: Chalouhi N , Zanaty M , Hasan D , Tjoumarkis S , Rosenwasser R , Jabbour P 
Published: July 2014

ObjectiveFlow diverters are increasingly used for treatment of intracranial aneurysms. In previous series, the Pipeline Embolization Device (PED) was used essentially for the treatment of unruptured aneurysms. Little is known about the use of the PED in ruptured aneurysms. We assess the safety and efficacy of the PED in the largest series of acutely ruptured aneurysms to date.MethodsA total of 20 patients with freshly ruptured aneurysms were treated with the PED between May 2011 and September 2013. Patients were loaded with aspirin and clopidogrel 8 h before the procedure. Platelet function was closely monitored throughout hospitalization using P2Y12 assays. Data on procedural safety was prospectively collected.ResultsMean aneurysm size was 6.6 mm. Fifteen aneurysms (75%) arose from the anterior circulation. The number of PEDs used was 1.0 per aneurysm. Treatment was staged (initial coiling followed by coiling 1–2 weeks later) in 4 patients (20%). Adjunctive coiling was used in 6 cases (30%). There was only 1 complication (5%) in the series; this was a fatal intraoperative aneurysm dome rupture that occurred during adjunctive coil deployment. At the latest follow-up (mean, 6.1 months), all but one aneurysm were completely occluded. No aneurysm required further treatment. All except one patient (95%) achieved a favorable outcome (mRS 0–2).ConclusionIn this study, treatment of ruptured aneurysms with the PED was associated with low complication rates, high aneurysm occlusion rates, and excellent clinical outcomes. These findings suggest that the PED is a safe and effective alternative for ruptured aneurysms non amenable to conventional endovascular techniques or surgical clipping. A staged approach that entails initial aneurysm coiling followed by coiling 1–2 weeks later appears to be an adequate strategy in this setting.DisclosuresN. Chalouhi: None. M. Zanaty: None. D. Hasan: None. S. Tjoumarkis: None. R. Rosenwasser: None. P. Jabbour: None.