bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-001 Initial Multicentre Clinical Experience with Treating Small Aneurysms (<5mm) with the Penumbra PC400 Large Volume Coil: Improving the Treatment of Small Aneurysms at 4 High Volume US Centres
Authors: Baxter B , Quarfordt S , Patel A , Moyle H , Turk A , Chaudry I , Turner R , Frei D , Huddle D , Bellon R 
Published: July 2013

Introduction/PurposeWe report clinical experience and long-term follow-up results in treating 24 small aneurysms in 22 patients, ranging from 2mm to 4.4mm, using the Penumbra PC400 Large Volume Coil at 4 high volume centres. Follow-ups are available for 12 aneurysms at the current time.Materials and MethodsOur treatment population consisted of 24 aneurysms ranging between 2 mm and 4.4 mm as measured by maximal aneurysm dimension, treated between February 2011 and September 2012. Seven were ruptured and 17 unruptured. Aneurysm location was 19 in the anterior circulation and 5 in the posterior circulation.ResultsThe average aneurysm size was 3.5 mm, with 52% average packing density. All aneurysms were treated entirely with PC400 coils, several with only 1 coil each. Fifty percent (50%) of the cases achieved an initial Raymond Scale of 1, 21% achieved a Raymond scale of 2, and 29% were Raymond Scale of 3. Half (12) of the aneurysms have angiographic follow-up at the time of this abstract. Based on the same/better/worse scale, 100% of aneurysms showed stable or improved angiographic outcomes at 6 months and one year. Seven had improved occlusion rating, and all the rest remained unchanged. We experienced a 0% overall rate of morbidity and mortality. One SAH patient had a thromboembolic event with no clinical sequelae, and 2 aneurysms had coil loop prolapse with no clinical sequelae, both patients being discharged with mRS 0. We continue to use the coils and accrue follow up and will update results at the time of the meeting.ConclusionOur clinical experience with the PC400 Coil system has demonstrated this .020" coil and 025 ID deployment catheter to be safe and efficacious in treating small aneurysms. Use of the PC400 Large Volume Coil results in high packing densities and high rates of occlusion on follow-up. The softness profile of this large volume coil can allow treatment of small aneurysms in some cases with only 1 coil, and the improved body of the deployment catheter has markedly improved the treatment of small aneurysms and perhaps made it safer.DisclosuresB. Baxter: 3; C; Penumbra, Inc. S. Quarfordt: None. A. Patel: 3; C; Penumbra, Inc. H. Moyle: None. A. Turk: 3; C; Penumbra, Inc. I. Chaudry: 3; C; Penumbra, Inc. R. Turner: None. D. Frei: 3; C; Penumbra, Inc. D. Huddle: None. R. Bellon: None.
P-002 The Two Catheter Technique in Comparison to Stent-Assisted Coil Embolisation in the Endovascular Treatment of Intracranial Aneurysms
Authors: Gaughen J , Durst C , Geraghty S , DeMartini N , Kreitel D , Medel R , Patrie J , Jensen M , Evans A 
Published: July 2013

Introduction/PurposeScientific data currently demonstrates the superiority of coil embolisation over open surgical clipping for the treatment of intracranial aneurysms. As technological advancements continue within the endovascular arena, these endovascular outcomes are expected to improve. Adjunct measures such as balloon remodelling and stent-assistance are increasing the percentage of intracranial aneurysms that can be treated endovascularly, and data is actively being collected to better understand the safety and efficacy of these adjunct modalities. The two catheter technique of endovascular aneurysm treatment is a competitive treatment strategies to these adjunct methods that involves the simultaneous deployment of coils through two catheters placed in an intracranial aneurysm sac for treatment of wide-necked aneurysms. This study evaluates the safety and efficacy of the two catheter technique in comparison to stent-assisted coil embolisation in the endovascular treatment of intracranial aneurysms.MethodsA retrospective chart review identified 110 consecutive aneurysms which were embolised using the two catheter technique and 101 consecutive aneurysms treated by stent assisted coil embolisation. Patient demographics, details of treatments, effects of treatments, results of follow up procedures, and complications were recorded. Comparison of the two catheter and stent groups was performed using Fisher’s exact test.ResultsThe technical success rates between the two-catheter and stent groups were similar at 91% and 95%, respectively. Primary occlusion rates were also similar at 14% for the two-catheter technique and 16% for stent-assisted embolisation. An additional 38% and 39%, respectively, had only neck remnants. As might be expected, recanalisation rates were slightly higher in the two catheter group, 25% vs 16%, though this was not statistically significant (p=0.141). This did not result in a statistically significant increase in the number of retreatments. Permanent morbidity was lower in the two catheter group, 7% vs 11%; however, this was not statistically significant (p=0.108).ConclusionThe two catheter technique appears to be as safe and effective as stent-assisted coil embolisation in the endovascular treatment of intracranial aneurysms. Although not statistically significant, the treatment trended towards lower permanent morbidity.DisclosuresJ. Gaughen: 2; C; Covidien. C. Durst: None. S. Geraghty: None. N. DeMartini: None. D. Kreitel: None. R. Medel: None. J. Patrie: None. M. Jensen: 2; C; Covidien, Microvention, Stryker. A. Evans: 2; C; Covidien, Microvention.
P-006 Safety and Efficacy of Endovascular Treatment of Paraophthalmic Internal Carotid Artery Aneurysms
Authors: Gaughen J , Durst C , Nguyen Q , Patrie J , Jensen M , Evans A 
Published: July 2013

Introduction/PurposeWithin the literature, controversy exists regarding the optimal treatment of ophthalmic segment internal carotid artery aneurysms. The close proximity of the ophthalmic artery and optic nerve increase the complexity of the disease, and the adjacent clinoid process impedes surgical exposure. This study investigates the safety and efficacy of coil embolisation for the treatment of paraophthalmic internal carotid artery aneurysms.MethodA retrospective chart review identified 79 consecutive aneurysms who presented for elective treatment of an ophthalmic artery aneurysm. Patient demographics, details of treatments, effects of treatments, results of follow up procedures, and complications were recorded. Odds ratios were used to measure the effect size. The McNemar Test for systematic discordance was used to test the likelihood of visual improvement or degradation.ResultsPrimary occlusion rate was 44%. The recurrence rate was 33%. In patients with at least 12 months follow-up, the size of the aneurysm (p=0.016), the size of the aneurysm neck (p=0.028), and hypertension (p=0.03) were predictive of the likelihood of recurrence. There were 3 major complications (4%). The average size of the aneurysm was greater in patients who experienced a major complication, though this did not reach statistical significance due to the low number of complications. 28 (35%) of the 79 patients presented with a visual disturbance that could be attributed to the aneurysm. Visual disturbances were experienced in those patients with larger aneurysms, though this was not statistically significant (p=0.285). Of the 28 patients with visual disturbance, 46% experienced improvement in their symptoms while none of the 51 patients who presented without visual disturbances developed a visual field defect postoperatively (p > 0.001).ConclusionEndovascular treatment of paraophthalmic internal carotid artery aneurysms appears to be a safe and effective treatment. Major complication rates were found to reside well within the expected rates for intracranial aneurysm treatment. Clinically, almost half of the patients who present with symptomatic visual disturbance or eye pain had significant improvement after treatment, and none of the patients presenting without visual disturbance demonstrated postoperative visual impairment.DisclosuresJ. Gaughen: 2; C; Covidien. C. Durst: None. Q. Nguyen: None. J. Patrie: None. M. Jensen: 2; C; Covidien, Microvention, Stryker. A. Evans: 2; C; Covidien, Microvention.
P-015 High Resolution- MRI Features of Reversible Cerebral Vasoconstriction Syndrome Over Time
Authors: Cerejo R , Hui F , Jones S , Obusez E , Hammad T , Hajj-ali R , Uchino K 
Published: July 2013

IntroductionReversible Cerebral Vasoconstriction Syndrome (RCVS) is associated with thunderclap headache, subarachnoid haemorrhage and potential ischaemic sequelae, with very different management than traditional central nervous system vasculitides. The advent of vessel wall imaging may help differentiate RCVS from other lesions, however knowledge of the imaging features of the syndrome over time may help physicians make the diagnosis with greater confidence.MethodsThe Cleveland Clinic 3-Tesla High resolution MRI (HRMR) database was retrospectively reviewed to identify patients with clinically diagnosed RCVS that also received HRMR yielding a total of 13 patients. Imaging protocol included black-blood gadolinium contrast-enhanced T1-weighted sequence with fat suppression and time-of-flight MRA of the circle of Willis. Imaging features were assessed by 2 experienced neuro-radiologists and indexed to time of imaging relative to the date of symptom onset. The images were then placed in sequential order, and features summarised as a function of time as an aggregate of patients.FindingsThe median age was 52 years with 2/13 (15%) being males. Median time to scan from symptom onset was 0.5 months. Mild vessel wall enhancement and thickening was noted in 4 patients (30%), while 6 patients had wall thickening alone. Remaining 3 patients only showed multifocal stenosis. Three patients (23%) were on steroids at time of initial scan. Nine patients (63%) had follow up imaging with a median follow up of 2.5 months. At follow up, 7/9 patients showed resolution of the enhancement and wall thickening while 1 patient had mild vessel wall enhancement and another had vessel wall thickening.ConclusionIn this limited retrospective review of RCVS patients, there is a clear improvement over time in terms of vessel wall enhancement and thickening. Vessel wall thickening and enhancement was more vivid at earlier time points and reduced over time. HRMR imaging of the vessel walls may provide corroboration of clinical onset and track resolution of RCVS as well as differentiate the disease from other vasculopathies. Further research is needed.DisclosuresR. Cerejo: None. F. Hui: None. S. Jones: None. E. Obusez: None. T. Hammad: None. R. Hajj-ali: None. K. Uchino: None.
P-018 Effect of pitavastatin on preventing ischaemic complications with carotid artery stenting: a multicentre prospective study
Authors: Takayama K , Myouchin K , Ikeda N , Sakamoto M , Nakagawa I , Wada T , Masuo O , Nakahara I , Tanemura H , Toma N , Maeda M , Suzuki H , Taki W 
Published: July 2013

BackgroundCarotid artery stenting (CAS) is becoming an alternative to carotid endarterectomy (CEA). However, periprocedural ischaemic stroke is one problem associated with CAS. Statin therapy can reportedly reduce periprocedural complication rates in coronary intervention. This study was designed to assess whether preoperative statin therapy reduces the risk of periprocedural ischaemic complications with CAS.Material and MethodsIn this prospective study at 11 centres, patients with carotid stenosis (symptomatic ≥50%, asymptomatic ≥80%) and at high risk of requiring CEA, but without previous statin treatment were divided into two groups by low-density lipoprotein cholesterol level (LDL-C). With LDL-C≥120 mg/dl, the previous stain (PS) group received pitavastatin at 4 mg/day for 4 weeks. With LDL-C <120 mg/dl, the non-PS group received no statin therapy for 4 weeks. After 4 weeks, both groups underwent CAS. Frequencies of new ipsilateral ischaemic lesions on diffusion-weighted imaging (DWI) within 72 h after CAS and major adverse events (MAEs) (defined as transient ischaemic attack, stroke, myocardial infarction or death) within 30 days were assessed.ResultsAmong the 80 patients enrolled, 61 patients (PS group, n=31; non-PS group, n=30) fulfilled the inclusion criteria. New ipsilateral ischaemic lesions were identified in 8 of 31 patients (25.8%) in the PS group and 16 of 30 patients (55.3%) in the non-PS group (P=0.027). MAE occurred in 0 patients in the PS group and in 3 of 30 patients (10.0%) in the non-PS group (P=0.07).ConclusionPretreatment with pitavastatin significantly reduced the frequency of periprocedural ischaemic complications associated with CAS.DisclosuresK. Takayama: None. K. Myouchin: None. N. Ikeda: None. M. Sakamoto: None. I. Nakagawa: None. T. Wada: None. O. Masuo: None. I. Nakahara: None. H. Tanemura: None. N. Toma: None. M. Maeda: None. H. Suzuki: None. W. Taki: None.
P-019 Large Vessel Strokes Incur A Significant Financial Burden For The Hospital - An Analysis Of Intravenous Thrombolysis For Acute Ischaemic Stroke
Authors: Rai A 
Published: July 2013

BackgroundLarge vessel occlusions constitute a substantial subgroup of ischaemic stroke patients that carry a high morbidity and mortality and poor outcomes. In order to classify these as a separate disease entity it is also important to demonstrate the higher financial burden associated with the current standard of care of intravenous thrombolysis for this subgroup. Future clinical trials comparing different treatments should thus be targeted at this high-risk group.MethodologyThe hospital charges, direct cost, total cost, length of stay, discharge destination, payments received and the DRG utilised were obtained for 237 acute ischaemic stroke patients who underwent intravenous thrombolysis over an 8-year period. Patients were divided into two groups based on the presence or absence of a large vessel occlusion (LVO) based on the admission CTA. A LVO was defined as involvement of the ICA-terminus, the MCA (M1 or M2 origin) or the BA. The functional outcome was defined as an mRS of 0–2 at 90 days. All financial parameters were compared for the two groups and the net gain/loss was calculated as the difference between the payments received and the total hospital cost.ResultsAs shown in table 1, the LVO-group (n=122) had significantly higher charges, direct cost and total cost as well as longer length of stay compared to the No-LVO group (n=115). Overall, there was no significant difference in payments received by the hospital. The hospital on average had a net loss of $1800 per LVO admission treated with IV thrombolysis as opposed to a net gain of $476 for patients in the No-LVO group (p=0.14). This difference however became larger and significant once patients who had died during their admission were excluded from the analysis. Amongst patients who survived and were discharged, the hospital had a net loss of $2952 per LVO patient versus a net gain of $572 for the No-LVO patient (p=0.03). In the LVO-group, 56% of the patients were discharged to a rehab facility as opposed to only 27% for the No-LVO-group (p<0.0001). Lastly, only 26% of the LVO patients achieved a favourable outcome versus a favourable outcome of 76% for the No-LVO-group.ConclusionLarge vessel strokes undergoing intravenous thrombolysis with rt-PA not only result in worse functional outcomes but also incur a significant financial loss, of almost $3000, for the hospital compared to patients without a large vessel occlusion.Abstract P-019 Table 1Comparison of Financial Parameters between the LVO and the NO-LVO GroupsLVO n=122 MeanNO-LVO n=115 MeanP-ValueSD (95%CI)SD (95%CI)CHARGES ($)$44,145$34,48935317 (37815-50475)20248 (30749-38230)0.01DIRECT COST ($)$13114$976010166, (11291-14936)5603, (8725-10795)0.002TOTAL COST ($)$18473$1377714218 (15925-21021)7955 (12308-15247)0.002PAYMENTS ($)$16657$1425313827 (14179-19135)14816 (11516-16990)0.19NET GAIN/LOSS $$-1816$47612146 (-3993-361)11784 (-1701-2652)0.14LOS - (Days)857 (7-9)4 (4-5)<0.0001DisclosuresA. Rai: 2; C; Stryker Neurovascular.
E-008 Packing Volume Densities by Coated vs Non-coated Coils in Endovascular treatment of Cerebral Aneurysms
Authors: Darwish M , Ku A , Aziz K , Williams R 
Published: July 2013

IntroductionHydrogel coils have been introduced to efficiently increase the aneurysmal packing volumes which may, in turn, decreases the recurrence rate of the endovasularly treated cerebral aneurysms. There is no definite evidence for this at present, however.MethodsThis is a retrospective study of our interventionally coiled aneurysms. We have divided these aneurysms into Ruptured and Unruptured aneurysms and each group has been further subdivided into those treated with either Hydrogel or bare platinum coils. Volume fill is based on use of the Angiocalc program.ResultsIn 301 patients, we have treated 354 aneurysms, 180 ruptured and 174 unruptured. We used the platinum coils in 95 ruptured and 87 unruptured aneurysms. The hydrocoated coils were used in 85 ruptured and 87 unruptured aneurysms. The average packing volumes resulted from the platinum coils were 46.37% and 52.36% in the ruptured and unruptured aneurysms respectively while the average packing volumes with hydrogel coils in the corresponding groups were 80.64% and 83.72% respectively. Total occlusion (packing volume = 100%) was achieved in 5 (5.26%) ruptured and 6 (6.9%) unruptured aneurysms treated with non-coated coils while it was achieved in 26 (30.59%) ruptured and 30 (34.48%) unruptured aneurysms treated with hydrocoated coils. Good packing volume (60%) was achieved in 29 (30.53%) ruptured and 31 (35.63%) unruptured aneurysms treated with non-coated coils while it was achieved in 71 (83.53%) ruptured and 80 (91.95%) unruptured aneurysms treated with hydrocoated coils. The overall average volume of aneurysms treated with non-coated coils was 156.75 mm3with an average packing volume of 49.2% while the overall average volume of the aneurysms treated with coated coils was 349.55 mm3with an average packing volume of 89.2%.ConclusionRegarding the aneurysmal packing volume, hydrocoils are proved to be more efficient than the conventional bare platinum coils in achieving higher packing densities at our institution. We currently use hydrogel coils for treatment of all coiled patients.DisclosuresM. Darwish: None. A. Ku: None. K. Aziz: None. R. Williams: None.
E-013 Effect of Procedural Time Required to Achieve Recanalisation with Mechanical Thrombectomy in Acute Ischaemic Stroke on Outcome: The Golden Hour of Stroke Intervention
Authors: Spiotta A , Vargas J , Turner R , Chaudry I , Battenhouse H , Turk A 
Published: July 2013

IntroductionOutcome studies in acute ischaemic stroke (AIS) have focused on time from symptom onset to treatment. The purpose of this study is to investigate whether time to achieve vessel recanalisation from groin puncture affects outcomes.MethodsWe studied all AIS cases that underwent intra-arterial therapy between May 2008 and October 2012 at a high volume centre. Candidacy for thrombectomy is determined by CT perfusion imaging, irrespective of time of onset. Patients were then dichotomised into two groups; “Early Recan” assigned in which recanalisation was achieved in sixty minutes or under from groin puncture and “Delayed Recan” in which procedures extended beyond sixty minutes. Time to recanalise was also studied as a continuous variable.Results180 patients (51.7% female, mean age 66.1 ± 15.1 years) were identified. Among the “Early Recan” patients, recanalisation was achieved in 41.4 ± 13.6 minutes as opposed to 101.5 ± 32.4 minutes in the “Delayed Recan” patients. Patients in the “Early Recan” group were twice as likely to achieve a TICI 3 (47% vs 24.6%; p=0.002) and a TICI of 2B or 3 (89.4% vs 72.8%; p=0.009). The intraprocedural complication rate was higher among the “Delayed Recan” patients (11.4%) compared to the “Early Recan” patients (3%; p=0.05). The likelihood of achieving a good outcome (mRS 0 - 2) was higher in the “Early Recan” group (54%) compared to the “Late Recan” group (29.8%; p=0.002). On logistic regression analysis, time to recanalise from groin puncture was found to significantly impact mRS at ninety days in addition to age, baseline NIHSS, achieving revascularisation, and postprocedure haemorrhage.ConclusionOur findings suggest that extending mechanical thrombectomy procedure times beyond sixty minutes increases complications and postprocedure haemorrhage rates while worsening outcomes. These findings can serve as a timeframe of when it is prudent to abort a failed thrombectomy case.DisclosuresA. Spiotta: None. J. Vargas: None. R. Turner: None. I. Chaudry: None. H. Battenhouse: None. A. Turk: None.
E-021 Acute Interventional Treatment of Atherosclerotic Carotid Occlusion and Intracranial Thromboembolism
Authors: Heck D , Brown M 
Published: July 2013

The patient presenting with acute carotid occlusion and intracranial embolism poses additional challenges compared with the patient with intracranial embolism and no cervical carotid obstruction. There are technical challenges of gaining access to the intracranial circulation for thrombolysis or embolectomy and decisions regarding pharmacologic management after placing a stent in an acutely occluded vessel, all of which may lead to additional complications. We report 18 consecutive cases of acute carotid occlusion or near occlusion treated in the last two years. Outcomes and procedural details were collected prospectively in our interventional stroke database. No patients have been lost to follow up. The mean age is 68 (median 65, range48–86). The mean NIHSS is 19 (median 19, range 9–26). Guidewire access was gained across the occlusion in all patients. In one patient stenting was not technically possible (only angioplasty) due to heavy calcification of the vessel, and in one patient the carotid terminus could not be opened after stenting of the cervical carotid occlusion. Normal flow was reestablished in the other 16 extracranial carotid arteries after stenting (89%). The 90 day mortality was 33%, with 3 cases of fatal haemorrhage (17%), all of which occurred in the first 24 hours. Favourable outcomes at 90 days (MRS 0–2) were obtained in 10 patients (55%), two of whom had favourable outcomes despite failed revascularisation of the middle cerebral artery after successful carotid stenting to improve inflow to pial collaterals. Overall, TICI 2B or greater flow was obtained in the middle cerebral artery in 14 patients (78%), TICI 2A or greater in 15 (83%). There was no embolisation to previously uninvolved territories (anterior cerebral artery or opthalmic artery). There were no delayed occlusions of carotid stents in patients who survived the initial stroke (n=12), and just one case of moderate restenosis at 6 months. In summary, favourable clinical outcomes and mortality in this cohort of patients treated with extracranial carotid stenting combined with intracranial embolectomy or thrombolysis for extracranial carotid occlusion and large vesse intracranial occlusion are similar to our patients who did not have extracranial carotid obstruction. However, the incidence of symptomatic haemorrhage is higher. We will compare the above results with our overall results and discuss technical aspects and strategies for anti-platelet therapy in this situation.DisclosuresD. Heck: None. M. Brown: None.