bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-010 Optical Coherence Tomography (OCT) Before and After Flowdiverter Treatment in Basilar Dolichoectasia
Authors: Brouwer P , Ligthart J , Regar E 
Published: July 2014

Optical Coherence Tomography (OCT) is an endovascular imaging modality that utilises infrared light to create high-resolution images of the vascular system. The use of OCT in cardiology is widely accepted and considered safe for imaging of the coronary artery wall, plaques and assessment of stent deployment.In the literature to date, OCT has not been used in endovascular imaging of neurovascular pathology. In this report we describe the first case in which OCT was used to evaluate pathology and assess the quality of the flow diverter treatment both directly after the treatment and at five months follow.The use of OCT proved to be feasible in neurovascular pathology and rendered more information than was anticipated about both morphology, underlying pathology, and treatment result at the treatment date as well as five month follow up.DisclosuresP. Brouwer: 3; C; BALT extrusion, Paris. J. Ligthart: None. E. Regar: None.
P-013 Predicting Mass Effect Exacerbation after Pipeline Embolization of Intracranial Aneurysms
Authors: Raychev R , Tateshima S , Jahan R , Gonzalez N , Szeder V , Vinuela F , Duckwiler G 
Published: July 2014

IntroductionIn this study, we investigated the clinical and procedural predictors associated with interval growth manifested as new or worsened mass effect after Pipeline Embolization Device (PED) placement for treatment of intracranial aneurysmsMethodsWe evaluated the baseline clinical and procedural characteristics of 46 consecutive patients who underwent 48 PED procedures. The clinical factors analyzed included age, history of smoking, history of hypertension, aneurysm size, pre-existing mass effect, platelet aggregation measured by ADP% inhibition, and administration of alternative antiplatelet treatment. Procedural factors included fluoroscopy time, adjunctive coiling, and device balloon angioplasty for optimal wall apposition. Univariate analyzes using Chi-square and T-test were conducted for categorical and continuous variables, respectively. Multivariate regression model was used to determine the strongest predictor of interval growth or worsened mass effect after PED placement. The logistic regression equation was used to determine cut off values for continuous variables included in the model.ResultsThe median age was 58 (5–88), 35/46 (76%) patients were female, and the median aneurysm size was 14.5 mm (2–38 mm). PED angioplasty was performed in 21/48 (44%) procedures, and adjunctive coiling was performed in 13/48 (27%) procedures. The median fluoroscopy time was 39 (15–314) min.15/46 (33%) of patients had pre-existing mass effect prior to PED placement, of which 3 had worsened symptoms and 2 had new mass effect after the procedure. Of the 5 patients who had new or worsened mass effect, 4 experienced complete symptomatic resolution, while 1 had a delayed aneurysm rupture requiring vessel sacrifice. 7/15 (46%) patients with pre-existing mass effect eventually experienced symptomatic improvement. Complete aneurysm occlusion rate at 6 months was 32/43 (74%).Among all baseline clinical and procedural factors, the strongest predictor of interval growth, manifested as new or worsened mass effect, was aneurysm size larger than 18mm (OR 15.51, p = 0.018).Conclusions1. New or worsened mass effect after PED placement may be anticipated in patients with intracranial aneurysm exceeding 18 mm in size. Although this phenomenon is uncommon and transient in most cases, physicians should be aware as pre-procedural counselling, administration of steroids, or close follow may be warranted.2. Overall, PED placement is an effective treatment of symptomatic mass effect from intracranial aneurysms with 46% success rate in our cohort.DisclosuresR. Raychev: None. S. Tateshima: 2; C; Covidien; Stryker; Penumbra; Reverse Medical; Pulsar Vascular. R. Jahan: 2; C; Covidien. N. Gonzalez: None. V. Szeder: None. F. Vinuela: None. G. Duckwiler: 2; C; Sequent; Covidien; Asahi.
P-015 A New Grading System for Predicting Angiogram Negative Subarachnoid Haemorrhage
Authors: Darie I , Rayan T , Amin-Hanjani S , Du X , Aletich V , Charbel F , Alaraj A 
Published: July 2014

IntroductionAngiogram negative subarachnoid haemorrhage (AN-SAH) account for about 15% of all non-traumatic SAH cases. In this paper we developed a new CT based grading system for distinguishing AN-SAH vs. aneurysmal SAH (a-SAH).MethodsA new CT grading classification was developed based on the Hijdra system. Patterns of SAH in 13 cisterns were scored between 0–2 depending on the amount of haemorrhage (0 = No blood; 1 = partial; 2 = full). The patterns of blood in the interpeduncular, pre-pontine and pre-medullary cisterns were scored in one category: P score (range 0–6); the total amount of blood in the entire 13 cisterns was scored under T score (range 0–26). Initial CT scans from 148 consecutive AN-SAH and 180 a-SAH patients were reviewed and scored by two independent blinded neurosurgeons. Patients with pure cortical or traumatic SAH or those with CT scan performed >72 h after the SAH ictus were excluded. All performed angiograms (1st, 2ndand 3rdlook, if performed) were reviewed for presence of aneurysms.ResultsIn patients with CT scan scores between P0-1;T > 9, the performed angiograms were positive in 92% (23 a-SAH vs. 2 AN-SAH), whereas in those scoring P0-1;T < 10 angiography revealed a much higher incidence of positive findings (52% a-SAH vs. 48% AN-SAH, p = 0.33). For Px; T < x+8 (xbetween 2–6), the angiograms were negative in 94.6% of cases (3 a-SAH vs. 53 AN-SAH), and in a subset of this category (P4-6; T < 14) the angiograms were negative in 100% of cases (n = 34). For patients scoring (P0-1; T < 10) and Px; T > x+7(xbetween 2–6) the scores were not predictive of angiogram results (65% a-SAH vs. AN-SAH 35%).ConclusionThe new CT scan scoring provides an estimate for the likelihood of a negative angiogram in patients with SAH. Significant blood in the pre-brainstem cisterns with minimal or modest blood in the remaining cisterns best predicts absence of aneurysm or vascular lesion on initial and follow-up angiography.DisclosuresI. Darie: None. T. Rayan: None. S. Amin-Hanjani: None. X. Du: None. V. Aletich: None. F. Charbel: None. A. Alaraj: None.
P-020 Emergent Carotid Artery Stenting with or without Intracranial Tandem Occlusion Lesions Following Carotid Endarterectomy
Authors: Vargas J , Zuckerman S , Chaudry I , Turner R , Turk A , Spiotta A 
Published: July 2014

IntroductionStroke in the immediate post-operative period following carotid endarterectomy (CEA) is usually due to carotid thrombosis. Many centers have begun incorporating angiography before re-exploration, which has the advantage of confirming carotid occlusion and treating tandem intracranial lesions. The aim of this study is to determine the safety and efficacy of this strategy.MethodsA retrospective review was performed of all cases undergoing stenting of the carotid artery following carotid endarterectomy from November 2009 to February 2014 at the Medical University of South Carolina and the Vanderbilt University Medical center. Charts and angiographic images were reviewed. Six cases of carotid thrombosis within 72 h of CEA and subsequent stent reconstruction are summarised.ResultsFive patients had greater than 70% carotid stenosis prior to carotid endarterectomy. One patient had intraoperative occlusion and dissection of the ICA which was noted on intraoperative carotid duplex ultrasound. All patients underwent post-operative computer tomography (CT) or computer tomography perfusion (CTP) scans with subsequent cerebral angiography and stent reconstruction within 11 h of symptom onset. Two patients had tandem middle cerebral artery M3 branch occlusion which was successfully recanalised. In all cases, recanalization was successfully completed between 40 to 160 min. There were no procedural complications.ConclusionEmergent endovascular evaluation in the setting of acute post CEA thrombosis is a safe and timely treatment option, with the benefit of detecting and treating embolic intracranial lesions. More investigation is necessary to define the role of immediate angiography and intervention in this rare surgical complication.Abstract P-020 Table 1Patient demographicsAgeGender% Carotid stenosisSymptomaticCase 166M90NCase 273M80–99YCase 378M70YCase 459F80–99YCase 555M80–99NCase 680MUnknownUnknownAbstract P-020 Table 2Pre procedural metricsTime from CEA to symptoms (hrs)Time from last normal to thrombectomy (hrs)NIHSS% Re-occlusionTandem intracranial lesionCase 11320100%NoneCase 200NA100%ICA dissectionCase 33.533150%M3 thrombusCase 4521123100%NoneCase 512.54100%NoneCase 64852100%Multiple M3 thrombiAbstract P-020 Table 3Peri and post procedural detailsProcedural time (min)Intraprocedural complicationsmRS at last follow upCase 140None0Case 2160None0Case 3120None6Case 445None3Case 560NoneNACase 6130NoneNADisclosuresJ. Vargas: None. S. Zuckerman: None. I. Chaudry: 2; C; EV3/Coviden, Microvention, Penumbra, Stryker, Pulsar, Blockade, Medina. R. Turner: 2; C; Coviden, Microvention, Blockade, Codman, Stryker, Reverse Medical, Pulsar Vascular, Siemens, Penumbra. A. Turk: 1; C; Stryker, Codman, Microvention, Penumbra, Siemens, Coviden. 2; C; Stryker, Microvention, Penumbra, Pulsar Vascular. 4; C; Pulsar Vascular, Lazarus Effect, Medina, Blockade. A. Spiotta: 2; C; Pulsar Vascular, Microvention, Penumbra.
P-021 TREVO Stent-Retriever Acute Stroke (TRACK) Post-marketing Registry: Interim Revascularization and Clinical Outcome Results Compared to TREVO-2 and NASA Registry
Authors: Zaidat O , Castonguay A , Veznedaroglu E , Binning M , Alshekhlee A , Abraham M , Mehta S , El Khoury R , Majjhoo A , Lin E , Kabbani M , Froehler M , Nguyen T 
Published: July 2014

BackgroundAlthough industry sponsored trials for newer mechanical thrombectomy devices for treatment of acute ischemic stroke (AIS) are promising, limited post-marketing data exist on the use of the TREVO device in every day clinical practice.ObjectiveThe ongoing TREVO Stent-Retriever Acute Stroke (TRACK) Registry aimed to assess the real-world safety, angiographic, and clinical efficacy of the TREVO device in comparison to the results from the TREVO-2 clinical trial and post-marketing North American SOLITAIRE Stent-Retriever Acute (NASA) Stroke Registry.Design/methodsThe TRACK Registry recruited clinical sites within the USA. Demographic, clinical, angiographic, and outcome data on patients treated with the TREVO device were collected. Symptomatic intracranial haemorrhage (sICH) was defined as any parenchymal hematoma, SAH, or IVH associated with a worsening of the NIHSS score by ≥4 within 24 h. The primary outcome was achieving TICI ≥2a revascularization. Secondary outcomes were mRS at 3 months, mortality, and sICH.Results12 centers contributed data on 93 patients for this interim analysis. Baseline demographics were: women 61.3% (57/93), white 78.5% (73/93), mean age 64.9 ± 17.8 years, median baseline NIHSS of 17 (IQR 14–22), mean fluoroscopic time 37.5 ± 31.9 min, and a mean procedure time of 101 ± 69.1 min. The TICI ≥ 2a and TICI ≥ 2b revascularization rates were 85.6% (77/90) and 65.6% (59/90), compared to the operator reported TICI ≥ 2a rate of 85% in TREVO-2 and 87.5% in NASA, and TICI ≥ 2b rate of 72.5% in NASA.A good outcome of mRS ≤ 2 was demonstrated in 43.0% (40/93), compared to 40% (TREVO-2) and 42% (NASA). The rate of sICH was 8.4% (7/83), compared to 4% (TREVO-2) and 9.9% NASA. 90-day mortality was 21.5% (20/93) versus 29% in TREVO-2 and 30.2% in NASA.ConclusionThe investigator initiated post marketing TRACK Registry demonstrates that the TREVO stent-retriever performance in clinical practice is comparable to the TREVO-2 trial and post-marketing NASA Registry.DisclosuresO. Zaidat: 1; C; Stryker Neurovascular. A. Castonguay: None. E. Veznedaroglu: None. M. Binning: None. A. Alshekhlee: None. M. Abraham: None. S. Mehta: None. R. El Khoury: None. A. Majjhoo: None. E. Lin: None. M. Kabbani: None. M. Froehler: None. T. Nguyen: None.
P-023 Transfontanelle and Transcardiac Veno-arterial Approaches for Embolization of Complex Pediatric Intra-cranial Vascular Malformations
Authors: Jagadeesan B , Zachararotos H , Shea K , Nascene D , Grande A , Tummala R 
Published: July 2014

IntroductionTrans-arterial endovascular embolization using liquid embolics for the treatment of intra-cranial vascular lesions can be challenging in neonates and infants due to difficulties with arterial access. This is particularly true when repeated procedures have to be performed for staged embolization of very complex lesions. Sometimes, there can be severe intra-procedural spasm or long standing occlusion of the femoral arteries, which can render arterial access very difficult. A Transvenous approach may also not be useful due to the angio-architecture of some of these lesions. Herein, we describe two patients in whom arterial access was compromised but embolization could still be carried out via alternate techniques.Case SeriesCase 1: A 2 week old infant presented with a Dural Sinus Malformation and a giant midline venous pouch, with multiple associated high flow arteriovenous fistulae. At the end of six trans-arterial embolization sessions with femoral arterial punctures, she still had residual high flow shunting. Both femoral arteries were small in calibre and the left was occluded. Therefore, the midline venous pouch was punctured via a percutaneous transfontanelle approach (through the posterior fontanelle) and the malformation was successfully embolised using Ethylene Vinyl Alcohol Co-polymer (Onyx) and coils while preserving the superior saggital sinus.Case 2: A 5 month old presented for elective embolization of an antenatally diagnosed mixed mural and choroidal type Vein of Galen Aneurysmal Malformation (VGAM). Both femoral arteries were small in size and developed severe vasospasm when an ultra-sound guided needle puncture was attempted precluding arterial access by this approach. Therefore, the right common femoral vein (CFV) was punctured under ultrasound and a 4 French Guiding catheter was passed through this puncture site and advanced to the right atrium. Eventually arterial access was obtained by navigating this catheter from the right atrium to the left atrium across the patent Foramen Ovale followed by advancement into the aortic arch. Embolization was then carried out successfully by the injection of Onyx or n-BCA from multiple pericallosal and choroidal arteries with approximately 50% reduction in flow through the VGAM.ConclusionPer-cutaneous Transfontanlle and Trans-cardiac percutaneous veno-arterial approaches for embolization may be useful in the treatment of selected intra-cranial vascular malformations in neonates and infants.DisclosuresB. Jagadeesan: 2; C; Covidien, Microvention, Lake Regional. H. Zachararotos: None. K. Shea: None. D. Nascene: None. A. Grande: 2; C; Covidien, Integra. R. Tummala: 2; C; Lake Regional.
O-006 Analysis of Screened Patients from the Penumbra THERAPY Trial: Correlations of Clot Length Assessed by Thin-Section CT in a Sequential Series of Acute Stroke Patients
Authors: Frei D , Heck D , Yoo A , Loy D , Buell H , Kamalian S , Morais L , Bitner A , Meyer D , Kuo S , Bose A , Sit S 
Published: July 2014

PurposeThin-section (≤2.5 mm) NCCT is a dependable method for measurement of clot length in documented anterior circulation occlusions. A majority of clots in the proximal anterior circulation are ≥8 mm, which have low probability of revascularization with IV rtPA alone. Nevertheless, past studies have had sampling restrictions, and correlations of clot length continue to be classified.MethodsData was captured to investigate potential correlates of clot length from an ongoing multicenter review. Patients were eligible if presented within 8 h of onset, had thin-section NCCT admission imaging, and evidence of ICA-T, M1, or M2 MCA occlusion. All patients had their occlusions documented by CTA, angiography, or MRI. Patients did not necessarily have thrombectomy performed. Baseline characteristics of interest included age, sex, baseline NIHSS, ASPECTS, occlusion level, IV rtPA dose pre vs. post scan, time from stroke onset to imaging, and IA recanalization. Univariate analyzes were implemented with clot length as a dichotomized variable (≥8 mm vs <8 mm), and multivariate logistic regression was used to define predictors.ResultsConsecutive stroke admissions were reviewed at 3 US centers between August 2011 and March 2013 for eligibility, and 175 patients met criteria. Mean age was 70 years old; 56% were female. Median baseline NIHSS score was 17 (IQR 12–22). The level of occlusion was distributed such that 23% were ICA-T, 54% M1, and 23% M2 MCA. Of the 175 confirmed occlusions, hyperdense clot was visible in 89% (156/175) of cases. Visible clot ranged from 2 mm to 65 mm, while mean length was 14 mm. There were 66% (115/175) patients with clot lengths ≥8 mm. In comparing clot length to occlusion level, 90% of ICA-T, 69% of M1, and 34% of M2 occlusions were ≥8 mm (p < 0.001), with median clot lengths of 20.5, 14.1, and 7.2, respectively. The only significant multivariate predictor of clot length was the occlusion level (OR, 95% CI =3.9 (2.2–6.9) per step from M2 to M1 to ICA-T, p < 0.0001).ConclusionThis analysis further supports the idea of measuring hyperdense thrombus by use of thin-section NCCT. Occlusion site is a key predictor of clot length, which may explain the relative ineffectiveness of IV rtPA in more proximal anterior circulation large vessels. These findings suggest a sizeable population who may benefit from a bridging approach.DisclosuresD. Frei: 3; C; Penumbra Inc. 4; C; Penumbra Inc. D. Heck: None. A. Yoo: 1; C; National Institutes of Health, Penumbra Inc., Remedy Pharmaceuticals. D. Loy: None. H. Buell: 5; C; Penumbra Inc. S. Kamalian: 1; C; GE Healthcare, Department of Defense, CIMIT. L. Morais: None. A. Bitner: 3; C; Penumbra Inc. D. Meyer: 5; C; Penumbra Inc. S. Kuo: 5; C; Penumbra Inc. A. Bose: 4; C; Penumbra Inc. 5; C; Penumbra Inc. S. Sit: 4; C; Penumbra Inc. 5; C; Penumbra Inc.
P-025 Interventional Treatment of High Flow Craniofacial Vascular Malformations
Authors: Dabus G , Linfante I , Lin E , Benenati J , Martínez-Galdámez M 
Published: July 2014

ObjectiveHigh flow craniofacial vascular malformations are uncommon lesions that pose a very difficult therapeutic challenge. They are locally aggressive lesions that can present in several different ways from completely asymptomatic lesions to significant bleeding, pain, neuropathy, tissue destruction or congestive heart failure. Several therapeutic strategies have been proposed including surgery, embolization or a combination of both. We report our experience in the treatment of high flow craniofacial vascular malformations.MethodsThe neurointerventional databases of 2 institutions were retrospectively reviewed from October of 2010 to March of 2014. All patients with high flow craniofacial vascular malformations were included in the analysis. Clinical presentation, location, type, agent and techniques used, procedural complications, clinical and imaging follow ups were included in the analysis.ResultsAmong the patients in our neurointerventional databases, 16 patients (11 females and 5 male) met the inclusion criteria in our study. Patients' ages ranged from 4 to 66 years old (mean 45.2 years). All patients were symptomatic (pain, bleeding and mass/disfigurement were the most prevalent symptoms). One patient had 2 separated arteriovenous malformations (one nasal and the other forehead/scalp). One patient with a nasal arteriovenous malformation had CM-AVM syndrome. Overall, there were 12 arteriovenous malformations and 5 arteriovenous fistuli treated in 26 embolizations procedures (ranging from 1 procedure to 4 procedures; mean 1.6 procedures). Onyx was the predominant agent used in 20 procedures. Two procedures were done using predominantly ETOH; 2 procedures were done using predominantly nBCA; and 2 procedures used only coils/particles. One procedure was performed using only transvenous route; direct puncture was the only access in 9 cases; transarterial technique was the only route in 12 procedures; and 4 procedures used combine transarterial and direct puncture techniques. In 26 procedures there was one procedural complication (skin ulceration). At the end of last treatment session 10 out of 16 patients had angiographic cure or minimal residual vascular malformation (5 AVFs and 5 AVMs). Symptomatic control was achieved in all cases with all patients stating that the symptoms had resolved or significant improvement (mean follow up 8 months). Five patients underwent scheduled surgery to remove the arteriovenous malformations.ConclusionsIn summary, high flow craniofacial vascular malformations are challenging diseases that can be successfully managed with interventional techniques providing symptomatic control.DisclosuresG. Dabus: 2; C; Covidien, Microvention, Reverse Medical. 4; C; Surpass Medical. I. Linfante: 2; C; Covidien, Stryker, Codman. 4; C; Surpass Medical. E. Lin: None. J. Benenati: 2; C; Gore, Cook, Penumbra, Covidien, Reverse Medical, Cordis, Surefire, Abbott, Angio Dynamics, MC-10. M. Martínez-Galdámez: 2; C; Covidien.
P-031 Single Center Experience with the ADAPT Technique for Acute Ischemic Stroke
Authors: Blanc R , Fahed R , Redjem H , Bartolini B , Pistocchi S , Piotin M 
Published: July 2014

BackgroundWe report our single center experience of endovascular treatment of stroke by a technique of direct aspiration with large bore catheter.MethodsFrom September 2013 to March 2014 we included prospectively on intent to treat 80 patients presenting with large vessels occlusion in the settings of acute ischemic stroke. The ADAPT technique was utilised in first intention in all patients and was associated with stentriever technique when necessary. Procedural and clinical data were collected for analysis.ResultsPatients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 15 (1–26). The localization of arterial occlusion was the MCA in 40/80 (50%), the ICA in 10/80 (12.5%), a tandem occlusion in 24/80 (30%) and the vertebro basilar territory in 6/80 (7.5%). The aspiration technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 43% of cases (38/80). The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 87.5%. With ADAPT alone, the average time from groin puncture to at least TICI 2b recanalization was 37 min (from clot contact to recanalization: 17 min). Ninety day functional outcomes was available for 35 patients were 50% (modified Rankin Scale (mRS) 0–2) and 15% (mRS 6). For the overall series there were 8 cases (10%) of procedural complications (one non occlusive dissection 4 distal emboli, and 5 Subarachnoid haemorrhages) and 2 symptomatic intracerebral haemorrhages (2.5%).DiscussionThe Aspiration technique utilising large bore aspiration catheters technique alone was effective in 43% of the cases being fast, safe and simple, nevertheless in our experience to achieve a recanalization rate of 87.5% it add to be completed by the use of stentrievers in the other cases. The relevance of this technique needs to studied in larger prospective multicentric studies.DisclosuresR. Blanc: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. 4; C; Lazarus. R. Fahed: None. H. Redjem: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. B. Bartolini: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. S. Pistocchi: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. M. Piotin: 2; C; Balt, Stryker, Covidien, Microvention, Neuravi, Penumbra. 4; C; Lazarus.