bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-049 In-Vitro Testing Of Stents Dedicated For The Carotid Arteries
Authors: Wissgott C , Schmidt W , Behrens P , Schmitz K , Andresen R 
Published: July 2013

ObjectiveThe design and material determine the mechanical properties of stents and implant behaviour during the intervention. In vitro parameters such as radial force, flexibility and wall adaptation of different stents were investigated in order to obtain evidence for clinical use.Material and MethodsA total of 8 current stent systems (Sinus Carotid RX, Cristallo Ideale, Adapt, Carotid Wallstent, Vivexx Carotid Stent, Xact Carotid Stent, Protégé Rx and Precise) with a diameter of 8 mm and a length of 40 mm, which are authorised for the treatment of carotid stenoses, were investigated. The radial force on expansion as a function of the diameter, the flexural rigidity of the stent system and of the stent in its expanded state, as well as the collapse pressure in a thin, flexible sleeve were measured. The wall adjustment of the expanded stents was documented by fluoroscopy after release in a step and curve model and assessed.ResultsThe flexural rigidity of the stent systems declined significantly in the expanded state, whereby the Xact Carotid stent showed the highest value (291.1 Nmm2) in contrast to 31.6 to 39.0 Nmm2for the Sinus Carotid and Cristallo Ideale. The radial force on expansion of the stents to 7 mm was lowest in the Adapt (0.009 N/mm) and highest in the Precise (0.068 N/mm), while the hybrid stents achieved values of between 0.027 and 0.046 N/mm. The collapse pressure was highest in the Carotid Wallstent as a result of its particular stent structure (0.48 bar), compared with the other stents (0.1 - 0.2 bar). The best wall adjustment in the curve model was shown by the Precise, the Sinus Carotid Rx and the Vivexx Carotid Stent. The diameter change from 5 to 7 mm was smoothly adapted by Cristallo Ideale and Carotid Wall Stent. The extraordinary design of the Adapt showed poor vessel wall adaptation both in step and curved vessels.ConclusionAs a result of their design, the Sinus Carotid Rx and the Cristallo Ideale in the “hybrid design” show the best wall adjustment, with comparable radial force and high flexibility, and thus can also be used in the case of an axis-deviant vascular course with variations in vessel diameter, whereby the Cristallo Ideale has the advantage that it has a “closed-cell” design in the middle third of the stent. In the event of unusual vascular anatomies, the other stents should be taken into consideration with their specifications in individual cases.DisclosuresC. Wissgott: None. W. Schmidt: None. P. Behrens: None. K. Schmitz: None. R. Andresen: None.
E-055 Ethanol and Coil Embolisation of Complex Dural Arteriovenous Fistula
Authors: Yakes W 
Published: July 2013

IntroductionTo evaluate the efficacy of ethanol, as well as ethanol and coils, in the management of complex dural AVF.MethodsFifteen patients (mean age 39 years; 10 females, 5 males). All patients presented with dural AVF involving the transverse sinus, sigmoid sinus and cavernous sinus. One patient suffered from high output cardiac state due to the massive size of her combined dural fistula and scalp AVM. All patients underwent MR and cerebral arteriogram evaluations. Patients underwent ethanol embolisation, coil embolisation or ethanol and coil embolisation in combination. These acquired AVF were non-traumatic.ResultsAll fifteen patients were endovascularly cured of their disease at a mean follow-up of five months. One patient’s therapy is on-going. In those patients who had thrombosed sigmoid sinuses and partially thrombosed transverse sinuses with critical venous drainage due to the occluded sinuses, novel endovascular approaches were utilised to reach the point of fistualisation and treat with coils and ethanol. Sacrifice of the diseased transverse and sigmoid sinus were also utilised to treat the large dural AVFs involving these segments. In the cavernous sinus only coil embolisation and nBCA embolic agents were utilised. In those patients presenting the pulsatile tinnitus, it was absent at follow-up. Headaches and all other symptoms were resolved. Except for one patient with a transient homonymous hemianopsia, no other complication occurred.ConclusionComplex acquired dural AVF can be treated by endovascular means. With meticulous technique complications can be avoided. Long-term cures have been documented with retrograde approaches within the dural sinuses using ethanol, coils, and at times nBCA. By this venous approach complications can be vastly diminished.DisclosuresW. Yakes: None.
E-057 Risk factors influencing duration of Cerebral Angiography: A single centre study.
Authors: Malhotra K , Schramke C , Ku A 
Published: July 2013

Introduction/PurposeCerebral angiography is an invasive procedure used for diagnostic and therapeutic purposes in cerebral atherosclerotic diseases. Prolonged duration of procedures has been linked with higher likelihood of complications. A better understanding of the factors that influence procedure duration is required to enhance patient safety, as they have important implications for both reimbursements and patient care.Materials and MethodsData were retrospectively collected over a two month period for a cohort of patients undergoing diagnostic cerebral angiography at our centre. Medical charts were reviewed and data were collected for patients regarding diagnoses of hypertension, hyperlipidaemia, diabetes, and tobacco abuse. We also recorded age, gender, weight and height for calculation of Body Mass Index (BMI), number of vessels studied, and procedure start and end time.Regression analysis was used to determine the factors that were most strongly associated with the duration of procedure. The variables included in this analysis were hypertension, hyperlipidaemia, diabetes, tobacco abuse, age, BMI>30, and the total number of vessels studied during the procedure. We also looked at correlation of total number of risk factors (hypertension, hyperlipidaemia, diabetes, tobacco abuse, BMI>30, and age>65) with the procedure duration in each patient.ResultsA total of 38 charts including 22 females and 16 males were identified and reviewed. The age of our patients ranged from 27 to 88 years with mean age 56.76 years, S.D = 14.2. Frequencies of various risk factors for the total sample were: hypertension (60%), hyperlipidaemia (45%), diabetes (9%), tobacco abuse (42%), BMI >30 (32%) and age>65 (26%). Using stepwise regression, we found that BMI>30 (p=0.010) and then age (p=0.021) were the strongest predictors of procedure length, and both in combination accounted for 30% of the total variance (p=.003). Correlational analysis showed a significant relationship between total number of risk factors and procedure duration (r=0.57, p=0.001). Surprisingly, total number of vessels studied during each procedure did not correlate with the procedure time (r= -0.043, p=.80).ConclusionPatient characteristics such as BMI and age are associated with prolonged duration of procedures. These risk factors does play an important role in the patient care and hence with the reimbursements of such procedures. Further large prospective studies are required to corroborate with our findings.DisclosuresK. Malhotra: None. C. Schramke: None. A. Ku: None.
E-061 Onyx Embolisation Through the Scepter Dual-Lumen System: Mechanisms and Utility
Authors: Chung C , Osanai T , Hui F 
Published: July 2013

IntroductionEthyl Vinyl Alcohol co-polymer Onyx (ev3 Inc., Irvine, CA) is a non-adhesive but cohesive liquid embolic agent that can be used to occlude vascular lesions. On label indications are for arteriovenous malformations, but the fluid has been useful in a variety of clinical scenarios including dural arteriovenous fistulae (dAVF), aneurysms, tumour embolisation and others. The key drawbacks of these techniques are in the time, material, and radiation needed for the formation of a proximal plug to force the flow of Onyx forward into the vascular territory, as well as the possibility of difficult catheter removal. The usage of Oynx in conjunction with the Scepter C dual lumen coaxial balloon system (MicroVention, Tustin, CA) can circumvent the need for plug formation and avoid associated drawbacks.Materials and MethodsThe endovascular database at a single institution was reviewed to assess for cases in which ethyl vinyl alcohol was used in conjunction with a Scepter C balloon. In each case, the Scepter C balloon was navigated to the target artery under fluoroscopic roadmap assistance. The balloon was inflated to occlude the vessel, and the lumen was flushed with DMSO. Onyx 18 embolisation was subsequently performed under continuous fluoroscopy until stasis was observed. The cases are reviewed and summarised with attention to fluoroscopy time between the initiation of ethyl vinyl alcohol embolisation and the cessation of ethyl vinyl alcohol embolisation.ResultsFive consecutive patients were treated with a combination of ethyl vinyl alcohol and the Scepter C balloon. In the three tumour cases, a total of six pedicles were embolised; in the dural fistulae cases, two pedicles were embolised. No immediate per-procedural complications occurred. Total fluoroscopy time, average fluoroscopy time per injection, and total time between initial injection and cessation of embolisation are accessed and compared to historical data on Onyx-only embolisation procedures. In a single case, reflux occurred secondary to a loose valve that led to an unplanned balloon deflation.ConclusionThe Scepter C balloon may be used off-label to deliver ethyl vinyl alcohol for the treatment of dAVF and tumour embolisation. Diminished fluoroscopy times and embolysate injection times may be achieved using an in-line balloon that results in an immediate block to retrograde flow, obviating the need to form a proximal “plug”. Further research is necessary to confirm safety and radiation exposure benefits, especially in arteriovenous malformations.DisclosuresC. Chung: None. T. Osanai: None. F. Hui: 3; C; MicroVention, Penumbra.
E-067 Permeability Surface Product as a Predictor of Haemorrhagic Transformation in Acute Ischaemic Stroke Intervention
Authors: Matthews A , Parker M , Rutledge N , Conrad K , Luci J , Bluett B 
Published: July 2013

Introduction/PurposeA significant complication in the intervention of acute ischaemic stroke is haemorrhagic transformation. It has been postulated that perfusion permeability imaging showing increased blood brain barrier permeability can be used to predict haemorrhagic transformation and possibly alter therapies.Materials and MethodsWe retrospectively reviewed 60 CT perfusion scans with permeability surface area product maps calculated using the Patlak model where IV tPA or endovascular thrombectomy was performed at our institution in 2012.ResultsPermeability maps were positive in 31 of the 60 cases. The size of the permeability change was medium to large in 29 of 31 cases (94%). Of the positive permeability cases only two (6%) subsequently developed haemorrhagic transformation (HT). One was a PH2 haemorrhage and one a HI2 haemorrhage. Both cases where HT occurred were successful (TICI 2b/3) endovascular thrombectomies. Neither of these cases developed malignant oedema, required hemicraniotomy or other intervention. No difference was found in the size or degree of the permeability changes and the incidence of HT.ConclusionElevated permeability on CT perfusion imaging had no relevant predictive value for haemorrhagic transformation in acute ischaemic stroke interventions at our institution.DisclosuresA. Matthews: None. M. Parker: None. N. Rutledge: None. K. Conrad: None. J. Luci: None. B. Bluett: None.
O-013 Intra-aneurysmal Flow Disruption: a New Approach for the Endovascular Treatment of Intracranial Aneurysms. French Clinical Experience
Authors: Pierot L , Januel A , Raoult H , Spelle L , Papagiannaki C , Desal H , Courtheoux P , Kadziolka K. Krzysztof , Gauvrit J , Moret J , Herbreteau D , Cognard C 
Published: July 2013

PurposeStandard coiling is now the first line approach for the treatment of intracranial aneurysms. However, this technique has some limitations, including treatment of wide-neck and large and giant aneurysms and recanalisations. Therefore, new techniques and devices are needed. The objective of intra-saccular flow disruption is the modification of aneurysmal flow by placing a device in the aneurysm sac. Preliminary clinical experience in French centres is presented.Materials and MethodsComputational fluid dynamics and pre-clinical testing (canine cross-over carotid bifurcation model) were used to develop an intra-saccular flow disrupter design, designated as WEB (Sequent, Aliso Viejo, CA).The WEB is a self-expanding, oblate, braided nitinol mesh, composed of an inner and outer braid held together by proximal, middle, and distal radio-opaque markers and creating two compartments: one distal and one proximal.Clinically, 39 patients (27F/12M, age: 37–75 years) harbouring ruptured, unruptured or recanalised aneurysms were treated between June 2011 and January 2013 in 7 French centres, using an intra-aneurysmal flow-disrupter (WEB).Aneurysm location was middle cerebral artery (23 aneurysms), basilar artery (8), internal carotid artery (5), and anterior communicating artery (3). Aneurysm size was 10mm in 5 aneurysms. Neck size was > 4mm in 5 aneurysms and <4mm in 35 cases.ResultsClinically, the device was successfully deployed in all but 2 cases. Three thromboembolic events were observed with favourable outcome in both cases (mRS ≤2). No intraoperative rupture was observed. No delayed rupture or remote haematoma was observed. Additional coiling was performed in 4 cases. Mid-term follow-up results are presented.ConclusionIntra-saccular flow disruption using WEB is a completely new endovascular approach to treat some types of aneurysm, particularly wide-neck bifurcation aneurysms. This preliminary clinical experience shows the safety and efficacy of the device when used in appropriately selected cases.DisclosuresL. Pierot: 2; C; Sequent. A. Januel: None. H. Raoult: None. L. Spelle: None. C. Papagiannaki: None. H. Desal: None. P. Courtheoux: None. K. Krzysztof Kadziolka1: None. J. Gauvrit: None. J. Moret: None. D. Herbreteau: None. C. Cognard: None.
E-074 Pipeline Strategies
Authors: Urdaneta A , Darflinger R , Chao K , Feng L 
Published: July 2013

BackgroundPipeline Embolisation Device (PED) is a flow diversion stent for the treatment of large wide neck aneurysms that are not well treated with coiling methods including stent assisting coiling. The PED material and design are relatively unique including its deployment.ObjectiveEvaluation of the PED procedures including issues during deployment and strategies to outcome problems.MethodsRetrospective multicentreed case series of 30 PED procedures for treatment of aneurysms. The cases were evaluated for issues that arose during PED deployment. The different strategies for managing problems was assessed for their effectiveness.ResultsThere were eight major issues with PED deployment. 1. Detachment from capture coil, 2. PED apposition to the vessel wall, 3. Torqueing or twisting of the PED, 4. Accurate placement of the PED, 5. Herniation of PED into aneurysm, 6. Advancing the microcatheter and removing the delivery system, 7. Accessing the distal outflow artery, and 8. Post procedure stroke within 3 days. Successful treatment strategies for each of the major issues demonstrated reasonable success.ConclusionPED is a 1st generation flow diversion stent with a variety of issues related to its deployment. However, familiarity with PED deployment strategies can result in a more successful deployment.DisclosuresA. Urdaneta: None. R. Darflinger: None. K. Chao: None. L. Feng: None.
E-080 Outcomes of Carotid Artery Angioplasty and Stenting in Patients after Treatment of Acute Ischaemic Stroke
Authors: Morone P , Mocco J 
Published: July 2013

Introduction and PurposeInternal carotid artery (ICA) angioplasty and stenting is a possible treatment modality for patients with acute stroke that is associated with carotid artery occlusion. Here we investigate the use of this combined technique and evaluate the results and outcomes of carotid artery recanalisation in patients presenting with acute ischaemic stroke.MethodsOver a period of six months, five patients with acute ischaemic stroke associated with cervical ICA occlusion underwent combined ICA angioplasty and stenting. A retrospective review was completed and clinical variables were measured and evaluated. Thrombolysis in cerebral ischaemia (TICI) score was used to define the degree of recanalisation, and a favourable outcome was defined as a Modified Rankin Scale (mRS) score of 0–3 at 90 days.ResultsThe mean patient age was 60.2 (range49–77) and the mean presenting National Institute of Health Stroke Scale was 17.8 (range16–19). Out of all patients, four had complete occlusion of the left ICA and one had complete occlusion of the right ICA. In four patients there was concomitant intracranial occlusion. The time from symptom onset to endovascular intervention was ≤ 3 hours in three patients, 10 hours in one patient and unknown in the other patient. Internal carotid angioplasty with stenting was completed in all patients. A TICI score greater than IIb was achieved in 100% of patients and grade III was achieved in 60% of patients. The 90 day mRS was 0–2 in 40% of patients and 0–3 in 80% of patients.ConclusionClinical outcomes suggest that carotid artery angioplasty when combined with stenting is a useful and reasonable technique for carotid artery recanalisation in patients undergoing an ischaemic stroke. Further studies need to be completed to assess the overall safety and efficacy of this combined technique for use of treatment in acute ischaemic stroke.DisclosuresP. Morone: None. J. Mocco: None.
O-016 Treatment of Intracranial Aneurysms with the LUNA AES Updated
Authors: Piotin M , Biondi A , Sourour N , Mounayer C , Andersson T , Söderman M , Mangiafico S , Jaworski M , Anxionnat R , Blanc R 
Published: July 2013

PurposeThe LUNA Aneurysm Embolisation System (AES) is a new self-expanding ovoid device that serves as an intra saccular flow diverter as well as a scaffold for endothelisation across the neck. The objective of this prospective clinical study aiming to include a total of 63 patients was to evaluate the ability of the AES to occlude intracranial aneurysms while maintaining patency of the parent artery.Materials and MethodsImmediate post-implantation occlusion grade (complete obliteration of the aneurysm including the neck), near-complete (persistence of any portion of the original defect of the arterial wall), or incomplete (any opacification of the sac) compared to baseline), and parent vessel compromise were evaluated. Patients underwent neurological testing with the Modified Rankin Scale and the National Institute of Health Stroke Scale (NIHSS) at baseline and time of discharge. Follow-up included clinical assessment at one, 3, 6, 9 and 12 months, and angiographic follow-up at 6 and 12 months.Results50 patients (9 men) with 47 unruptured and 4 ruptured saccular aneurysms (38 bifurcation, 13 sidewall, sizes from 3.9 to 10.1 mm) were enrolled to date in the study. In all but 2 aneurysms (2 failed procedure converted in coiling) 1 LUNA AES was deployed per aneurysm. In 5 cases, the LUNA AES placement was carried out with balloon microcatheter assistance. In one case, the LUNA AES placement was carried out with a stent. In 1 case, AES placement led to aneurysm perforation that was controlled by temporary balloon occlusion and heparin reversion. In 1 case, thrombo-embolic complication was treated with i.a. injection of Abciximab. Clinical follow up was uneventful in all but 2 patients (one sustained SAH from a contralateral MCA aneurysm, one had GI bleeding). Immediate complete/near complete occlusion was obtained in 22.5% (22/49). At 6 month follow-up, complete/near complete occlusion was obtained in 70.4% (19/27). There was no parent artery stenosis or occlusion. None of the treated aneurysm (re)bled during follow-up.ConclusionPreliminary results demonstrate good safety profile. Angiographic follow up are promising with no recanalisation.DisclosuresM. Piotin: None. A. Biondi: None. N. Sourour: None. C. Mounayer: None. T. Andersson: None. M. Söderman: None. S. Mangiafico: None. M. Jaworski: None. R. Anxionnat: None. R. Blanc: None.
O-020 Head and Neck Endovascular Repair of Vascular Malformations
Authors: Yakes W 
Published: July 2013

ObjectiveTo determine the efficacy of ethanol embolotherapy of extracranial head and neck vascular malformations of all types, particularly after failure of other endovascular and surgical treatments.MethodsOne hundred and sixty-six patients (64 males, 102 females; mean age: 38 yrs) presented with extracranial arteriovenous malformations (AVMs) of the head and neck area. Over half of the patients had undergone previous failed therapies. All patients underwent ethanol embolotherapy under general anaesthesia. Forty-five patients had AVMs and 121 patients had venous malformations (VM).ResultsOf 45 AVM patients, 26 patients are cured (mean follow-up 2½ years); of 121 venous malformation patients, 65 are at end-therapy (mean follow-up 4½ years). The remaining patients are not at end-therapy and are being treated for their residual malformations. In AVM follow-up, arteriography is the main imaging modality to determine cure or residual AVM as MR is less sensitive in the evaluation of residual AVM. In VM follow-up, MR is the main imaging tool, particularly with T-2 fat suppression and/or STIR imaging. All patients demonstrated improvement post-therapy. Complications were 4.5%, to include bleeding (self-limited), partial 7th nerve palsy (with recovery), skin injury (not requiring skin grafts), infection, and pain.ConclusionsEthanol has proven its consistent curative potential at long-term follow-up for high-flow AVMs and low-flow VM lesions at long-term follow-up as lesions in the periphery. Complication rates remain low. The procedures are tolerated well by the patients and done on an out-patient basis. Prior surgery and embolisation procedures can cause difficulty in lesion access, but does not obviate further ethanol endovascular treatment.DisclosuresW. Yakes: None.