bluuebunny/crossref_metadata_2025_split huggingface dataset:
O-017 Minimally Invasive Angiographic CT Guided Evacuation of Parenchymal and Ventricular Haemorrhage Using the Apollo System: Proof of Concept in a Cadaver Model
Authors: Fiorella D , Arthur A 
Published: July 2014

IntroductionApollo (Penumbra Inc, Alameda, CA) is a low profile irrigation-aspiration system designed for the evacuation of intracranial haemorrhage. We demonstrate the feasibility of using Apollo through a minimally invasive approach using angiographic CT guidance.MethodsParenchymal (n = 1) and mixed parenchymal-intraventricular hematomas (n = 1) were created in cadaver heads using a transvascular (n = 1) or transcranial (n = 1) approach. Hematomas were then imaged with angiographic CT ((ACT), dynaCT, Seimens Medical Imaging, Erlanger, GE) and the long axis of the hematoma defined. The ACT data were then used (iGuide, Siemens Medical Imaging) to guide transcranial access to the hematoma-defining the location of the burr hole and the path to the leading edge of the hematoma. A 8F vascular sheath was then placed under live fluoroscopic guidance into the hematoma. A second ACT was performed to confirm localization of the sheath. The hematoma was then demarcated on ACT and the Apollo system was introduced through the 8F sheath under live fluoroscopic guidance (iPilot, Siemens Medical Imaging). Following irrigation-aspiration with Apollo, repeat ACT was performed to document reduction in hematoma volume.ResultsBoth transvascular and transcranial techniques were successful in creating intracranial hematomas. Hematomas could be defined with conspicuity sufficient for localization and volumetric measurement using ACT. Live fluoroscopic guidance was effective in navigating a sheath into the leading aspect of a parenchymal hematoma and guiding irrigation-aspiration with the Apollo system. Irrigation-aspiration with Apollo reduced the intracranial haemorrhage volume more than 80% in both cases. The Apollo system was activated for 189 seconds and 300 in the first and second subjects, respectively.ConclusionsThe described cadaver model is a useful means by which to study interventional techniques for intracranial haemorrhage. It seems feasible to use ACT to guide the evacuation of parenchymal and intra-ventricular haemorrhages using the Apollo system through a minimally invasive trans-cranial access.DisclosuresD. Fiorella: 1; C; Siemens, Penumbra. A. Arthur: 1; C; Siemens, Penumbra.
O-018 Magnetically Assisted Remote-controlled Endovascular Catheter for Interventional MRI:In VitroNavigation at 1.5 T versus X-ray Fluoroscopy
Authors: Hetts S , Losey A , Lillaney P , Cooke D , Thorne B , Saeed M , Arenson R , Wilson M 
Published: July 2014

PurposeTo advance the field of endovascular interventional MRI, which could allow real-time assessment of brain tissue viability during acute ischemic stroke interventions, we have developed a prototype MRI compatible magnetically assisted remote controlled catheter (MARC). We sought to compare navigation of a MARC catheter under real-time MRI with manual navigation under MRI and standard x-ray guidance in endovascular catheterization proceduresin vitro.Materials and MethodsA custom clinical-grade micro catheter prototype with a solenoid coil at the distal tip was deflected with a foot pedal actuator used to deliver current of 300 mA. Investigators navigated the catheter into branch vessels in a cryogel abdominal aortic phantom. This was repeated under MR imaging guidance without magnetic assistance and under conventional x-ray fluoroscopy. MR experiments were performed at 1.5T using a balanced steady-state free precession sequence. The mean procedure times and percentage catheterization success data were determined and analyzed with a linear mixed-effects regression analysis.ResultsThe catheter was clearly visible under real-time MRI. One hundred ninety-two (80%) of 240 turns were successfully completed with magnetically assisted guidance versus 144 (60%) of 240 turns with non-assisted guidance (P = 0.001) and 119 (74%) of 160 turns with standard X-ray guidance (P = 0.028). Mean procedure time was shorter with magnetically assisted than with non-assisted guidance under MRI (37 seconds vs 55 seconds, P = 0.001), and time was similar between magnetically assisted and standard x-ray guidance (37 seconds vs 44 seconds, P = 0.045). When stratified by angle of branch vessel, magnetic assistance was faster than nonassisted MRI guidance at turns of 45°, 60°, and 75°.ConclusionIn this study, a MARC catheter for endovascular navigation under real-time MRI guidance was developed and tested. For catheterization of branch vessels arising at large angles, magnetically assisted catheterization was faster than manual catheterization under MR imaging guidance and was comparable to standard x-ray guidance. This represents a significant advance in MRI guided catheterization and brings the performance of MRI guided stroke interventions closer to clinical reality.DisclosuresS. Hetts: 1; C; NIH-NIBIB, NIH-NCI, Siemens, Covidien. 2; C; Stryker, Penumbra, Silk Road Medical, Medina Medical. 4; C; Medina Medical, ChemoFilter. A. Losey: None. P. Lillaney: None. D. Cooke: 1; C; Siemens. 4; C; Viket. B. Thorne: None. M. Saeed: None. R. Arenson: None. M. Wilson: None.
O-002 Single Center Experience Comparing Outcomes of Strokes Treated with Mechanical Thrombectomy vs Without Mechanical Thrombectomy Using CTP for Patient Selection
Authors: Vidal G , Milburn J , Pansara A , Jennings B , Sabharwal V 
Published: July 2014

PurposeMost patients with large vessel occlusion (LVO) present with high NIHSS, and it has been shown that initial NIHSS is a predictor of outcomes in patient with acute ischemic stroke. The usefulness of neuroendovascular reperfusion has been a controversial topic. The aim of this study was to compare the outcomes of patients with large vessel occlusion strokes treated with neuroendovascular procedures versus those who received conservative treatment, based on a 2-year (2012–2013), single center experience at Ochsner Medical Center in New Orleans, LA.Materials and methods116 consecutive patients who had both CTA confirmed intracranial LVO and CT-Perfusion data upon arrival to our institution were retrospectively studied. Patients with haemorrhages, tandem lesions, or high grade carotid stenosis were excluded from this analysis. The decision to perform endovascular treatment was made by the vascular neurologist and the neuro-interventionalist based on stroke severity and CTA/Perfusion data. Patients in group 1 (n = 50) underwent endovascular revascularization procedures, while patients in group 2 (n = 66) were treated conservatively (medical management alone or with IV t-PA if within treatment window). Presentation NIHSS, risk factors, mortality, discharge NIHSS, discharge mRS, and follow up mRS were recorded and compared. Onset of symptoms to CT-Perfusion time was also studied.ResultsThere were no statistical differences in the patient population regarding in age, gender, and risk factors. Also, there was no statistical difference in their presentation/initial NIHSS (17.7 vs. 19.6, p = 0.1236). However, the 2 groups were statistically different in their discharge NIHSS (7.82 vs 18.26, p < 0.00001), discharge mRS (2.42 vs 4.30, p < 0.00001), clinic follow up mRS (2.1 vs 4.12, p < 0.00001), mortality (8% vs 21%, pr = 0.043), and good outcome at discharge (mRS 0–2) (62% vs 14%, pr < 0.00001). There was a statistically significant difference between the groups regarding onset of symptoms to CTA/Perfusion imaging (6h 28 m vs 8 h 26 min, p = 0.0247).ConclusionPatients who presented with high NIHSS, LVO, and favorable CT-Perfusion data who underwent neuroendovascular reperfusion treatment had significantly better outcomes and decreased mortality in our patient population, despite having similar stroke severity at presentation. This highlights the importance reperfusion, time to treatment, and collateral flow to maintain tissue viability. This study also suggests that CT-Perfusion imaging may be useful to select patients who will benefit from neuroendovascular reperfusion therapy for LVO ischemic stroke.DisclosuresG. Vidal: 3; C; Penumbra Inc, Covidien. J. Milburn: 3; C; Penumbra Inc. A. Pansara: None. B. Jennings: None. V. Sabharwal: None.
O-022 A New Protocol for Anticoagulation with Tirofiban during Stenting of Intracranial Aneurysms
Authors: Chalouhi N , Zanaty M , Starke R , Jabbour P , Hasan D 
Published: July 2014

IntroductionStenting techniques such as stent-assisted coiling and flow diversion are increasingly used for treatment of intracranial aneurysms. In previous reports, patients were pretreated were aspirin and clopidogrel prior to the intervention for prevention of thromboembolic complications. Prior studies also often rely on aspirin response and P2Y assessment, which often delays treatment in non-responders. The present study assesses the safety and efficacy of a new protocol for anticoagulation using tirofiban during stent-assisted coiling and flow diversion of intracranial aneurysms.MethodsIn this prospective study, all patients received a 0.10 mcg/kg/min maintenance infusion of tirofiban intraoperatively without a loading dose. The infusion was started immediately after deployment of the stent or flow diverter and continued for 12 h following the procedure. No patient was pretreated with aspirin or clopidogrel. Data on procedural safety was prospectively collected.ResultsA total of 128 aneurysms were treated with this protocol. Mean patient age was 56.2 years. Of these patients, 82 underwent stent-assisted coiling and 46 underwent flow diversion with the Pipeline Embolization Device (PED). Twenty-eight patients (22%) were treated in the setting in subarachnoid haemorrhage. There were only 2 (1.6%) thromboembolic complications and 2 (1.6%) haemorrhagic complications (1 subclinical worsening of the computed tomographic appearance of a subarachnoid haemorrhage and 1 post-PED parietal haemorrhage that was managed conservatively) in the series. The rate of treatment-related permanent morbidity and mortality were only 0.8% and 0%, respectively.ConclusionThe results of this study suggest that a protocol of anticoagulation with a maintenance infusion of tirofiban during stent-assisted coiling and flow diversion of intracranial aneurysms has an excellent safety profile. This protocol provides a reasonable alternative to pre-treating with aspirin and clopidogrel. The protocol is also particularly useful in patients with ruptured aneurysms or when the use of a stent was unexpected.DisclosuresN. Chalouhi: None. M. Zanaty: None. R. Starke: None. P. Jabbour: None. D. Hasan: None.
O-028 Endovascular Treatment of Small-Unruptured Cerebral Aneurysms with Flow Diverters
Authors: Piotin M , Bartolini B , Redjem H , Pistocchi S , Blanc R 
Published: July 2014

PurposeTo assess the safety and efficacy issues of Flow Diverters (FD) in the treatment of small unruptured cerebral aneurysms.MethodsRetrospective review of a prospectively gathered database of endovascularly treated aneurysms since the introduction of FD. From September 2008 (when treatment aneurysms with FD was initiated at our institution) to January 2014, 519 small (<10 mm), unruptured aneurysms were treated by endovascular means. Four treatment modalities were individualised: simple coiling, balloon-assisted coiling, stent-assisted coiling and aneurysm neck coverage with FD.Results(87/519) 16.8% (mean sac size: 5.0 mm, 70.1.4% bifurcation) of aneurysms were simply coiled.(189/519) 36.4% (mean sac size: 4.9 mm, 54.5% bifurcation) of aneurysms were coiled with balloon assistance.(166/519) 32.0% (mean sac size: 6.1 mm, 75.3% bifurcation) of aneurysms were coiled with stent-assistance.(77/519) 14.8% (mean sac size: 5.0 mm, 14.5% bifurcation) aneurysms were treated with FD.Procedural perioperative and delayed (up to 180 days) permanent neurological complications were 0.0%, 4.0%, 10.1% and 3.1% respectively, with a marked trend for more complications with stent-assisted coiling (P = 0.0037). Total immediate aneurysm occlusion was obtained in 49.4% (43/87), 53.4% (101/189), 59.0% (98/166) and 3.9% (3/77) respectively, with a marked trend toward better occlusion with stent-assisted coiling technique (P < 0.0001). At a mean angiographic follow-up of 16 months for aneurysms treated with FD and 23 months for the others, total aneurysm occlusion was 59.2% (32/54), 70.4% (88/125), 85.4% (111/130) and 70.7% (41/58) respectively, with a trend toward better occlusion with stent-assisted coiling (P = 0.0011).ConclusionsFD for the treatment of small-unruptured aneurysms confer a good safety profile that compares favorably with those of balloon-assisted technique, but are mostly indicated for sidewall aneurysms. Occlusion rates at follow-up are better with stent-assisted-coiling than FD but with higher morbidity.DisclosuresM. Piotin: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. 4; C; Lazarus Effect. B. Bartolini: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. H. Redjem: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. S. Pistocchi: 2; C; Covidien, Stryker, Balt, MicroVention, Penumbra. R. Blanc: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. 4; C; Lazarus Effect.
P-003 Endovascular Concurrent Use of Coils and Pipeline Embolization Device for Intracranial Aneurysms: Clinical and Angiographic Results
Authors: Nossek E , Chalif D , Lombardo K , Setton A 
Published: July 2014

BackgroundThe utility of the pipeline embolization device (PED) has been described as the sole device for treatment of brain aneurysms. The benefit using concurrent coils with limited number of PEDs is not well documented. We describe our experience with this technique as well as our mid-term clinical and angiographic results.MethodsThis is a retrospective review of patients treated for brain aneurysms between 2011–2014. In this cohort, 1–3 PEDs were deployed with the addition of coils using a “jailed” microcatheter technique. A partially dense coil mass was the goal, without complete neck occlusion. Technical difficulties were reviewed. Immediate clinical and angiographic results were obtained as well as mid-term and long-term clinical outcome and aneurysms occlusion rate. Once a patient demonstrated complete occlusion on contrast MRA, Plavix was discontinued.ResultsWe have treated 26 patients using this technique. Median Age was 50.5 (range 31–78). The following aneurysms were treated: 1 Cavernous aneurysm; 17 proximal supraclinoid carotid, 3 posterior communicating artery aneurysms, 2 anterior choroidal artery aneurysms, 1 ICA bifurcation aneurysms and 2 intradural vertebral aneurysm. All underwent early post procedure clinical follow up.There were no intra-procedural or post-procedural complications. All PEDs were successfully deployed. No early or delayed neurological nor neuro-ophthalmological deficits were encountered. No adverse effects due to the coil mass were observed. There were no clinical and radiographic signs of ischemia in this group. Steroids treatment was tapered quickly and discontinued within 5 days, without prolong severe headaches. During the imaging follow up, all patients demonstrated complete occlusion on the first MRA (3–5 month). Follow DSA angiography (6–9 month) confirmed complete occlusion without in-stent stenosis. All patients maintained their baseline clinical status.ConclusionsWe found that the deployment of limited PEDs with concurrent partially-dense coil embolization is safe and effective. This technique achieved early complete occlusion without inducing mass effect. Favorable clinical results were observed in all patients without prolong headaches.DisclosuresE. Nossek: None. D. Chalif: None. K. Lombardo: None. A. Setton: None.
O-004 Final Results of the US Humanitarian Device Exemption Study of the Low-profile Visualised Intraluminal Support (LVIS) Device
Authors: Fiorella D , Derdeyn C , Turk A , Boulos A , Diaz O , Pride G , Jabbour P , Woo H 
Published: July 2014

IntroductionThe Low-profile Visualised Intraluminal Support (LVIS) Device is a novel, braided, intracranial microstent designed for stent-assisted coiling. We present the results of a single-arm, prospective, multicenter trial of the LVIS for the treatment of wide-necked intracranial aneurysmsMethods31 patients with unruptured, wide-necked (neck >4 mm or dome : neck ratio <2) intracranial aneurysms were treated with the LVIS device and bare platinum coils at 6 US centers (IDE G110014). Clinical follow was conducted at 30d and 6 months. Angiographic follow up was performed at 6 months. The primary safety endpoint was any major stroke or death within 30 days or major ipsilateral stroke or neurological death within 6 months. Probable benefit was defined as >90% angiographic occlusion at 6 months. An independent core lab adjudicated angiographic results. An independent clinical events committee adjudicated clinical endpoints.ResultsAverage aneurysm size was 7.2 mm (STD 3.8) and average neck width was 4.6 mm (STD 3.1). 68% of patients had a dome: neck ratio >2. LVIS placement was technically successful in 29 of 31 patients (93.5%). No primary safety endpoints occurred during the study (0%). No patient had a higher modified Rankin Score at 6 months when compared to baseline. 26 of 28 (92.9%) treated aneurysms with 6 month angiographic follow-up demonstrated >90% angiographic occlusion. Of these, 21 (75%) were completely occluded at follow up.ConclusionsThe LVIS device facilitated the coil-embolization of wide-necked intracranial aneurysms with high rates of technical success, an excellent safety profile and very high rates of complete and near complete occlusion at follow up.DisclosuresD. Fiorella: 1; C; Microvention/Terumo, Sequent Medical, NIH, Siemens Medical Imaging. 2; C; JNJ/Codman, ev3/Covidien. 4; C; Vascular Simulations, CVSL. C. Derdeyn: 1; C; Terumo/Microvention. A. Turk: None. A. Boulos: None. O. Diaz: None. G. Pride: None. P. Jabbour: None. H. Woo: None.
P-009 WEB Endovascular Treatment of Wide-neck Bifurcation Aneurysms: Short- and Midterm Results in a European Study
Authors: Pierot L , Klisch J , Gauvrit J , Szikora I , Leonardi M , Liebig T , Nunzi N , Boccardi E , Di Paola F , Holtmanspötter M , Weber W , Calgliari E , Lubicz B 
Published: July 2014

Background and purposeFlow disruption with the WEB-DL device has been used safely for the treatment of wide-necked bifurcation aneurysms but the stability of aneurysm occlusion after this treatment is unknown. This retrospective multicenter European study analyzed short- and midterm data in patients treated with WEB-DL.MethodsTwelve European neurointerventional centers participated to the study. Clinical data, pre- and post-operative, short-, and midterm images were collected. An experienced interventional neuroradiologist independently analyzed images. Aneurysm occlusion was classified in 4 grades: complete occlusion, opacification of the proximal recess of the device, neck remnant, and aneurysm remnant.ResultsForty-five patients (34 females and 11 males) aged 35 to 74 years (mean: 56.3 +/- 9.6 years) harbouring 45 aneurysms treated with the WEB device were included. Aneurysm locations were middle cerebral artery in 26 patients, posterior circulation in 13, anterior communicating artery in 5, and internal carotid artery terminus in 1. Forty-two aneurysms were unruptured. Good clinical outcome (mRS < 2) was observed in 93.3% of patients. Adequate occlusion (Complete occlusion, opacification of the proximal recess, or neck remnant) was observed in 30/37 patients (81.1%) in short-term follow-up (median 6 months) and in 26/29 patients (89.7%) in midterm follow-up (median 13 months). Worsening of aneurysm occlusion was observed in 2/28 patients (7.1%) in midterm follow-up.ConclusionsThe results suggest WEB treatment of wide-neck bifurcation aneurysms offers stable occlusion in aneurysms that are usually unstable. Additionally, our data show that opacification of the WEB recess can be delineated from true neck or aneurysm remnant.DisclosuresL. Pierot: 2; C; Sequent. J. Klisch: None. J. Gauvrit: None. I. Szikora: None. M. Leonardi: None. T. Liebig: None. N. Nunzi: None. E. Boccardi: None. F. Di Paola: None. M. Holtmanspötter: None. W. Weber: None. E. Calgliari: None. B. Lubicz: None.
E-002 Efficacy of the Pipeline Embolization Device in the Treatment of Previously-treated Aneurysms
Authors: Park M , Nanaszko M , Sanborn M , Moon K , McDougall C , Albuquerque F 
Published: July 2014

IntroductionThe Pipeline Embolization Device (PED, eV3 Neurovascular, Irvine, California) has increased the ability of the neurointerventionalist to treat progressively more difficult cerebrovascular pathology. We sought to determine the efficacy of the PED in the treatment of the most recalcitrant of aneurysms, those aneurysms recurring after previous treatments.Materials and methodsWe retrospectively queried a prospectively maintained endovascular database for previously treated cerebral aneurysms undergoing intervention with the PED from May 2011 to the present time. Twenty-two patients (4 male, 18 female; age range 30–78 yrs, average 59.3 yrs) were treated for 23 aneurysms (average size 11.9 mm, SD 8.5 mm) requiring 29 PED (average 1.3 PED/pt) during the study period. Fourteen patients were originally treated with neuro-interventional procedures (6 coil Embolization, 7 stent assisted coil Embolization, 1 stent only), whereas, eight patients were originally treated with open surgery (7 clipping, 1 wrapping). Of the eight clip recurrences, two patients had an additional neuro-interventional treatment with subsequent recurrence prior to PED use. Average length of follow-up was 8.5 months.ResultsThe overwhelming majority of all patients in our cohorts had their final angiographic outcomes rated as improved (20 Better, 2 Same, 0 Worse) compared to the pre-procedure state. Furthermore, 11 patients had final Raymond scores of 1 and 11 patients had final Raymond scores of 2. There were no final Raymond 3 angiographic results in the series. Those patients who recurred following initial endovascular treatment had better final Raymond scores when compared to the open surgery cohort (9 of 14 Raymond 1 scores versus 2 of 8 Raymond 1 scores).ConclusionsIn our single center series, PED use for the treatment of recurrent aneurysms is an effective means of treating this difficult subset of patients. We observed that the vast majority of these patients will go on to have excellent angiographic outcomes following PED placement. Further investigations are needed to better elucidate the role of the PED in this cohort.DisclosuresM. Park: None. M. Nanaszko: None. M. Sanborn: None. K. Moon: None. C. McDougall: None. F. Albuquerque: None.