bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-074 Emergency Carotid Artery Stenting in Acute Ischemic Stroke
Authors: Ohara N , Tateshima S , Sayre J , Duckwiler G , Jahan R , Gonzalez N , Vespa P , Ali L , Saver J , Liebeskind D 
Published: July 2014

Introduction/purposeRecanalization of occluded arteries is crucial for good functional outcome of acute stroke patients with large vessel occlusion. Endovascular treatment, particularly mechanical thrombectomy, plays an increasing role to achieve rapid recanalization. However, some patients with acute large vessel occlusion have additional extracranial cervical carotid artery occlusion or severe stenosis. Although these patients might undergo carotid stenting to achieve recanalization of intracranial occlusions, such stenting causes challenges in subsequent clinical management. The purpose of this study was to evaluate the safety and efficacy of endovascular recanalization treatment with emergency carotid artery stenting for acute stroke patients.Materials and methodsWe analyzed clinical and angiographic data of patients who underwent emergency cervical internal carotid artery (ICA) stenting in the setting of acute endovascular recanalization treatment in our institution between May 2005 and December 2012. Reperfusion was assessed according to the modified Thrombolysis in Cerebral Infarction (mTICI) score. Clinical outcome was evaluated at discharge and at 3 months after treatment by modified Rankin Scale (mRS).Results23 patients were included in this cohort. The mean age was 63.3 years. The median NIHSS score on admission was 20 (range, 3–25). The median Alberta Stroke Program Early CT Score on diffusion-weighted imaging (ASPECTS-DWI) on admission was 7 (range, 2–10). 17 patients (73.9%) had ICA occlusion at the origin. 19 patients (82.6%) had intracranial tandem vessel occlusions. All patients successfully underwent carotid artery stenting and 15 patients (65.2%) underwent additional mechanical thrombectomy for intracranial vessels. After the procedure, 9 patients (39.1%) were mTICI grade >IIb. Haemorrhagic transformation with parenchymal hematoma occurred in 9 patients (39.1%) and 2 (8.7%) was symptomatic. At discharge and at 3-months follow-up, 6 patients (26.1%) had a favorable outcome (mRS0–2). The multiple logistic model yielded age (P = 0.018) and initial ASPECTS-DWI (P = 0.029) independently associated with a favorable outcome and additionally mechanical thrombectomy (P = 0.003) was associated with haemorrhagic transformation with parenchymal hematoma.ConclusionEndovascular recanalization treatment with emergency carotid artery stenting is technically feasible. Further refinement of patient selection may reduce postprocedural hemorrhaghic transformation and optimise resultant clinical outcomes.DisclosuresN. Ohara: None. S. Tateshima: None. J. Sayre: None. G. Duckwiler: None. R. Jahan: None. N. Gonzalez: None. P. Vespa: None. L. Ali: None. J. Saver: None. D. Liebeskind: None.
O-019 Re-treatment Rates Following Pipeline Embolization Device Alone versus Pipeline and Coil Embolization of Cerebral Aneurysms: A Single Center Experience
Authors: Park M , Nanaszko M , Sanborn M , Moon K , Albuquerque F , McDougall C 
Published: July 2014

IntroductionThe introduction of the Pipeline Embolization Device (PED, eV3 Neurovascular, Irvine, California) has increased the complexity of the cerebral aneurysms which can be treated with neuro-interventional techniques. We sought to compare the recurrence rates following PED alone versus PED and coil embolization (PED/coil) of intracranial cerebral aneurysms in our single center.Materials and MethodsWe retrospectively examined a prospectively maintained endovascular database for cerebral aneurysms treated with the PED with or without coils from May 2011 to the present time. One hundred and thirty three patients (25 males, 108 females; age range 23–85 years; average 60.4 yrs) were treated for 140 aneurysms (average size 11.8 mm, SD 8.3 mm) requiring 224 PED (1.7 PED/pt) during the study period. Sixty-eight patients (13 males, 55 females) were treated with PED alone for 72 aneurysms (average 10.7mm, SD 9.2 mm). Whereas, 65 patients (12 males, 53 females) were treated with PED/coil of 67 aneurysms (average 12.8 mm, SD 7.0 mm)ResultsEight aneurysms in eight patients were re-treated in the PED alone cohort versus only one aneurysm in one patient in the PED/coil cohort for an 11.7% (8/68) versus 1.5% (1/65) re-treatment rate respectively. The average time for re-treatment in the PED alone cohort was 6.5 months (SD 3.8) while the PED/coil re-treatment occurred at 10 months. Two patients in the PED cohort were re-treated due to PED contraction/migration while the other six patients were re-treated for enlargement or persistent filling of the aneurysms. The PED/coil patient had significant improvement in the aneurysm filling, but had small persistent endoleak into the aneurysm.ConclusionsIn our single center experience, PED/coil of cerebral aneurysms resulted in a lower re-treatment rate compared to PED alone. This result may provide the basis for future evaluation with randomised, controlled trials.DisclosuresM. Park: None. M. Nanaszko: None. M. Sanborn: None. K. Moon: None. F. Albuquerque: None. C. McDougall: None.
O-023 Embolization with a Novel Endovascular Coil in a Canine Intracranial Saccular Aneurysm Model
Authors: Jahan R 
Published: July 2014

IntroductionEndovascular treatment of aneurysms with coils is based on the assumption that dense packing leads to intra-aneurysmal flow reduction with subsequent thrombosis and occlusion. Despite significant advances in technology, anatomic results remain suboptimal with residual and recurrent aneurysms being a drawback of the coiling procedure. In this report we describe a novel device for treatment of intracranial aneurysms and report safety, technical feasibility and anatomic outcomes in a canine aneurysm model.Materials and methodsThis study tested novel endovascular coils (Medina Medical, Menlo Park, California) consisting of a linear radiopaque mesh that, when deployed, self-expands to a three-dimensional shape that conforms to the aneurysm. Coils were deployed via standard endovascular techniques in surgically-created carotid aneurysms in canines. Device performance and procedural angiographic data were collected. Animals were survived through 30, 90, or 180 days when follow-up angiography was performed followed by sacrifice and histopathologic evaluation.Results38 aneurysms in 22 animals were evaluated. The average dome size was 7.5 mm (SD: 1.2; range: 5.3–10.4) with an average neck of 4.2 mm (SD: 0.7; range: 2.8–6.1). There was no vasospasm, parent vessel thrombus or device migration during the procedure. In 27 aneurysms (71%), one coil was implanted. 35 aneurysms (92%) required two or fewer coils. Implanting physician ratings of device usability factors averaged 4.7 out of a maximum rating of 5.At follow-up, 25 aneurysms (69%) showed angiographic occlusion of 90–100%. Subsequent histologic analysis demonstrated that 27 aneurysms (75%) were completely occluded with mature fibrous tissue. Two device migrations occurred in the post-operative period. No evidence of thrombosis or device corrosion was found in any animal. Inflammation was minimal and of a chronic nature.ConclusionThe technical feasibility of this embolization coil for occlusion of saccular aneurysms was demonstrated and usage ratings were positive. In contrast to reports of platinum coils in aneurysms of similar size, relatively few devices were required for each aneurysm; most required only one or two coils.The device was effective at all chronic follow-up time points, with at least two-thirds of aneurysms showing 90% or greater occlusion. Complete aneurysm occlusion with organised fibrocellular tissue seen in the majority of cases may result in a permanent and stable occlusion that could result in fewer recanalizations and minimise the need for re-treatments. Overall, this initial report of preclinical outcomes with a new embolization coil reveals promising results.DisclosuresR. Jahan: 2; C; Covidien, Medina Medical, Stryker.
O-026 Safety and Efficacy of Detachable Tip Microcatheter for Embolization of Brain Arteriovenous Malformation
Authors: Paramasivam S , Altschul D , Fifi J , Ortega Gutiarrez S , Berenstein A 
Published: July 2014

PurposeWe describe our experience using detachable tip microcatheters in the embolization of brain arteriovenous malformations, pial arteriovenous fistulas and vein of Galen malformations. We discuss the safety and efficacy using the detachable tip microcatheter.MethodsDuring a period 9 month from March 2013 through March 2014, 16 pediatric patients in 21 procedures with 39 total injections were selected for treatment with a detachable tip under an FDA compassionate use exemption, and were admitted to our department for treatment of their brain AVM using a liquid embolic agent and a detachable tip microcatheter. The ages of the patients ranged from 3 months to 18 years old.ResultsOf the 39 total injections done, in 13 Onyx 18 or Onyx 34 was used. In those, the Catheter tip detached in one case (1/13) (7.5%). In the remaining 26 catheterizations out of the total 39, n-BCA was used for embolization. In those Catheter tip detached in eleven cases (11/26) (42%). There were no cases of premature microcatheter detachment during normal vessel navigation.DiscussionThe navigability of the Apollo™ microcatheter is comparable or better to other available over the wire microcatheters. The injection of Onyx or concentrated n-BCA is well controlled and allow reflux in a controlled fashion. The withdrawal is done in a less traumatic controlled fashion with graduated pressure under fluoroscopic guidance. We believe this to result in less chance of catheter entrapment, vessel rupture and haemorrhage.ConclusionA detachable tip microcatheter offers an advance in the safety and effectiveness of Onyx or nBCA embolization. It permits a true circumferential occlusion, and may further permit filling a larger amount of angioarchitecture. The catheter retrieval becomes more controlled and less traumatic. Our initial experience is encouraging and more experience is needed to categorically ascertain its safety and efficacy.DisclosuresS. Paramasivam: None. D. Altschul: None. J. Fifi: None. S. Ortega Gutiarrez: None. A. Berenstein: None.
O-003 Resolution of Cranial Neuropathies Following Treatment of Intracranial Aneurysms with the Pipeline Embolization Device
Authors: Moon K , Albuquerque F , Ducruet A , Crowley R , McDougall C 
Published: July 2014

IntroductionIntracranial aneurysms, especially those of the cavernous segment of the internal carotid artery (ICA), can present with cranial nerve palsies. Few studies exist reporting the outcomes of cranial neuropathies following treatment with the Pipeline Embolization Device (PED).MethodsA prospectively maintained endovascular database was reviewed for all patients treated with the PED after presenting with one or more cranial nerve palsies secondary to a cerebral aneurysm since May 2011. Patient charts were reviewed to report clinical and angiographic outcomes. Only patients with clinical follow-up were included in the analysis.ResultsSince FDA approval, 127 patients were treated with the PED at our institution. Twenty-two patients presented with cranial neuropathies for initial inclusion in this study. Of these, 20 patients had sufficient follow-up for analysis. Cranial neuropathies included those of CN II, III, V, and VI, with presenting symptoms of diplopia, decreased visual acuity, and facial numbness/pain. Thirteen lesions were cavernous segment ICA aneurysms, whereas the remainder included supraclinoid and petrous segment ICA, posterior communicating artery and basilar trunk aneurysms. At a mean follow-up of 9.55 months, 15 patients (75%) had resolution or significant improvement of their cranial neuropathies and 5 had stable symptoms. Twelve (66.7%) of 18 patients with angiographic follow-up demonstrated complete obliteration or small neck residual, whereas 6 (30.0%) had residual lesion. Patients with complete/near-complete obliteration were significantly more likely to demonstrate symptomatic improvement at follow-up (p = 0.009). Two patients with persistent symptoms were eventually treated with microsurgical bypass. Complications in this series included six (30.0%) transient extracranial haemorrhagic complications related to antiplatelet therapy, and one delayed asymptomatic ICA occlusion following retreatment.ConclusionTreatment of intracranial aneurysms presenting with one or more cranial nerve palsies results in a high rate of clinical improvement after treatment with the PED. Clinical outcomes must be weighed against the risks and challenges faced with flow diverters.DisclosuresK. Moon: None. F. Albuquerque: None. A. Ducruet: None. R. Crowley: None. C. McDougall: None.
O-030 Preliminary French Registry Clinical Experience with the Barrel Bifurcation Vascular Reconstruction Device
Authors: Piotin M , Blanc R , Berge J , Turjman F 
Published: July 2014

Background/purposeEndovascular Stent-assisted coiling is a well establish technique for treatment of wide-necked intracranial aneurysms. However, it remains a challenge to successfully treat complex wide-necked bifurcate aneurysms by using a single-stent and double (X and Y) stenting introduce other procedural variables. The purpose of the French Barrel™ Prospective Registry, an intention to treat study, is to investigate a single stent technique utilizing a novel fully retrievable barrel-shaped vascular reconstruction device for wide-necked bifurcate aneurysm stent assisted coiling treatment.Methods8 patients were enrolled within the French Barrel Registry thus far. This is a review of initial cases performed at the three French centers where Barrel VRD Device (Reverse Medical Corp, Irvine, CA) was used. Elective treatment was performed between December 2013 and March 2014. In this case series, various models of Barrel VRD device were utilised as neck-bridging devices in wide-necked bifurcate aneurysms in conjunction with embolization coils. These cases included; ACoA, MCA, Carotid Terminus, and Basilar Tip aneurysms.Results7 patients were treated with a single Barrel VRD device, at three French sites. Patients were placed on a double anti-platelet protocol (Clopidogrel and ASA) prior to treatment. 1 patient was enrolled, but not treated due to being a low anti-platelet responder. Patients presented with wide-necked bifurcate aneurysms measuring 4.71+/-1.62 mm necks and 1.33 +/- 0.39 mm dome/neck ratios. Aneurismal parent and branching vessel diameters were 2.69 +/- 0.44 mm and 2.45 +/- 0.25 mm, respectively. Technical success was 100% (7/7), and all embolizations were deemed clinically acceptable with initial Raymond Grade-1 in 5/7 (71%), Grade-2 in 1/7 (14%), and Grade-3 in 1/7 (14%) post-procedure. In all cases, the Barrel devices were easily positioned, via a 021 microcatheter, and offered both trans-cell or “jailed” coil microcatheter placement, good neck bridging and coil mass support, and fairly rapid detachment. As the device is resheathable, it could be placed into either branching bifurcation vessel, depending on which vessel position offered better neck coverage. No procedural Barrel device migration or coil loop protrusion was noted. Additionally, the device could be manipulatedin situto further optimise neck coverage. Discharge mRS was 0 for all patients. AE’s included 2 groin hematomas, and 1 aneurysm coil perforation, related to the procedure, not the Barrel device.ConclusionsThe initial French Barrel Registry results demonstrate that the Barrel VRD device is new tool for the endovascular treatment of wide neck bifurcate type aneurysms.DisclosuresM. Piotin: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. R. Bpanc: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. J. Berge: None. F. Turjman: None.
O-034 Carotid Artery Angioplasty versus Stenting in Acute Ischemic Stroke
Authors: Choudhri O , Gupta M , Feroze A , Albers G , Lansberg M , Do H , Dodd R , Marcellus M , Marks M 
Published: July 2014

IntroductionAcute ischemic stroke secondary to cervical carotid artery occlusion can lead to significant morbidity and mortality. Acute carotid occlusion may be managed by carotid angioplasty, stenting, or both. The use of carotid stents requires patients to be placed on dual antiplatelet agents, which may contribute to increased haemorrhage risk. We undertook this study to evaluate outcomes for angioplasty alone versus stenting in the setting of acute carotid occlusion.MethodsAll patients treated from 2008 to 2013 with acute cervical internal carotid artery occlusions that had intervention within eight hours of symptom onset were included. NIHSS were recorded preceding intervention, and clinical outcomes were assessed using mRS at 90 days. All imaging and angiographic data were reviewed for pre-procedural ASPECT scores, pre- and post- TICI reperfusion scores, and intracranial haemorrhage as defined by PH grading score for haemorrhage. Demographic and treatment factors were correlated with good functional outcome (mRS < 2 at 90 days and a comparison was made for patients undergoing angioplasty alone versus stenting. All patients who underwent carotid stent were placed on dual antiplatelet agents while angioplasty patients received aspirin only.ResultsTwenty-four patients (15 males, 9 females; mean age, 67 years) satisfied the inclusion criteria. Seventeen patients underwent placement of carotid stent and 7 patients had angioplasty alone. Patients in both subgroups were comparable across characteristics including comorbidities, time for onset to recanalization, ASPECTS, and IV tPA use. 35% of patients who underwent stenting had good functional outcomes, versus 71% of patients treated with angioplasty alone, although these differences were not statistically significant. No differences were seen for the two treatment groups comparing time from onset to recanalization, baseline ASPECTS, and IV tPA use. Additionally, increased age (p = 0.049) and post-treatment parenchymal haemorrhage- PH1 or PH2 (p = 0.016) correlated with poor outcomes (mRS > 2). All parenchymal haemorrhages (6/17) and deaths (5/17) fell within the stenting subgroup (35.3% and 29.4%, respectively).ConclusionsThis data suggest that patients undergoing angioplasty alone in the setting of acute internal carotid artery occlusion may have improved functional outcome at 90-day compared to those undergoing stenting. This study was limited by a small sample size and a larger study would be needed to confirm these findings.Keywordsangioplasty, stenting, acute ischemic stroke, carotid occlusion.DisclosuresO. Choudhri: None. M. Gupta: None. A. Feroze: None. G. Albers: None. M. Lansberg: None. H. Do: None. R. Dodd: None. M. Marcellus: None. M. Marks: None.
P-004 Radiation Dose Analysis of Large and Giant Internal Carotid Artery Aneurysm Treatment with the Pipeline Embolization Device versus Traditional Coiling Techniques
Authors: Colby G , Lin L , Nundkumar N , Jiang B , Huang J , Tamargo R , Coon A 
Published: July 2014

BackgroundFlow diversion is an effective and increasingly accepted method for endovascular treatment of cerebral aneurysms. Additionally, the public has heightened concerns regarding radiation exposure from medical procedures. This study analyzes radiation dose and fluoroscopy time during treatment of large and giant proximal internal carotid artery (ICA) aneurysms with the pipeline embolization device (PED) versus traditional coiling techniques.MethodsRadiation dose, fluoroscopy time, and contrast dye administration were retrospectively analyzed in 55 patients undergoing endovascular treatment of aneurysms ≥10 mm from petrous to superior hypophyseal ICA segments. Patients were treated by either PED (37 patients) or traditional coiling techniques (18 patients). Aortic arch type and proximal ICA tortuosity were also assessed as markers of access difficulty.ResultsAverage radiation dose with PED treatment was 2840 ± 213 mGy and 4010 ± 708 mGy with traditional coiling techniques (p = 0.048; 29% decrease with PED). Mean fluoroscopy times for PED were 56.1 ± 5.0 min and 85.9 ± 11.9 min for coiling cases (p = 0.0087; 35% decrease with PED). These benefits existed despite more difficult arch anatomy and trend towards greater proximal vessel tortuosity in PED cases. Contrast dye amounts were also reduced by 37.5% in PED cases (75 ± 6 cc) versus coiling cases (120 ± 13 cc, p = 0.0008).ConclusionsTreatment of large and giant proximal ICA aneurysms using PED requires less radiation, less fluoroscopy time, and less contrast administration than standard coiling techniques. This further demonstrates the benefits of flow diversion for treatment of these aneurysms.DisclosuresG. Colby: 2; C; Covidien. L. Lin: None. N. Nundkumar: None. B. Jiang: None. J. Huang: None. R. Tamargo: None. A. Coon: 2; C; Covidien, Stryker.
P-007 Incidence and Management of Intimal Hyperplasia at 6 months after Flow Diversion for Intracranial Aneurysms
Authors: Massari F , Puri A , Hou S , Perras M , Brooks C , Stout C , Gounis M , Wakhloo A 
Published: July 2014

Introduction/purposeA new option in the treatment of large and complex intracranial aneurysms centerd along the cavernous/intradural segment of the ICA, proximal to the PCom artery, includes the utilization of flow-diverter devices. Intracranial stent/ flow diverter deployment in the treatment of aneurysm usually requires the administration of dual antiplatelet therapy for 3–12 months. Our usual protocol is to switch to mono-therapy with Aspirin after 6 months. We analyzed the results after continuing dual anti-platelet therapy based on the intimal hyperplasia (IH) noted on the 6 month follow-up cerebral angiography. The purpose of this study is to assess at 1-year follow-up the efficacy of mono or dual antiplatelet therapy in the management of in-PED IH observed at the 6-month cerebral angiogram.Materials and methodsFrom October 2011 to February 2014, a total of 93 intracranial aneurysms in 83 patients (16 men and 67 women; age range, 19–85 years; mean age, 56.6 years) were treated with pipeline embolization device (PED) at our institution. A cone-beam CT (Philips, Allura Biplane FD20/20, Philips Medical, Best, Netherlands) was obtained using the angiography C-arm to assess for IH at FU angiographies. At 6-month follow-up (39 patients with 46 aneurysms) 8 cases of in-PED no-flow limiting minimal IH (< 10% vessel stenosis) were noted. In these patients medical management using continuation of dual antiplatelet therapy for additional 6 months up to a 1 year cerebral angiogram follow-up was used.ResultsIn the 8 patients having IH at the 6 months angiogram, 4 patients have till now underwent a 1 year follow-up. Complete resolution of the intimal hyperplasia was seen in 3 patients, whereas a stable IH was noted in one patient. One year follow up angiography was available for an additional 11 patients, who did not have IH at the 6 month FU. The 1 year FU angiography in these patients demonstrated no interval development of IH after stopping Clopidogrel at the 6 month time period.ConclusionIn our experience the adjustment of antiplatelet drug therapy post endovascular PED treatment of intracranial aneurysm depending on 6 month follow up findings is strongly associated with complete Pipeline Embolization Device patency at 1-year follow-up. Furthermore in our experience cone-beam CT is an accurate and precise tool in the assessment of in-PED intimal hyperplasia development during follow-up.DisclosuresF. Massari: None. A. Puri: None. S. Hou: None. M. Perras: None. C. Brooks: None. C. Stout: None. M. Gounis: None. A. Wakhloo: None.