bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-072 Image Guided Targeted Radiofrequency (t-RFA) and Sacroplasty of Hypervascular Sacral Metastases for Pain Control
Authors: Zablow B 
Published: July 2013

Haematogenous metastases to the sacrum can produce significant pain and lead to spinal instability. Conventional surgery to palliate pain with acceptable morbidity and mortality has been problematic given the usual short life expectancy of these patients and the high incidence of surgical complications. The Dfine STAR radiofrequency ablation system was recently approved for clinical use for the treatment of pain associated with bony spinal malignancy and other painful benign spinal lesions. In the subgroup of patients with hypervascular metastatic hepatocellular and renal cell cancer to the sacrum without neurological deficits, t-RFA and Sacroplasty using flat panel RCT or CT Fluroscopy in conjunction with electrophysiological monitoring preceeded by transarterial sacral embolisation has proven to be an effective method of pain palliation with extremely low morbidity in the eight patients performed to date. These patients have markedly reduced their requirements for narcotic analgesics and in most instances regained the ability to ambulate previously precluded by pain.DisclosuresB. Zablow: None.
E-076 Fistulae at the Falx and Tentorium cerebelli; Liverpool series
Authors: Nahser H , Puthuran M , Chandran A , Javadpour M , Eldridge P 
Published: July 2013

Dural arteriovenous fistulae at the falx and at the an terior and posterior margin of the tentorium cerebelli drain into cortical veins exclusively and their most common mode of presentation is haemorrhage. The concept of dural fistulae that involve smaller sinuses at the tent and falx was introduced by PICARD (1990, Journal of Neuroradiologie 17,161–181). We have retrospectively analysed a series of patients treated in between 2002 and 2012. 12 were found to be located at the falx and 30 located at the tent. One patient with an unruptured fistula died before treatment because of a haemorrhage. All other patients except one were treated initially with embolisation via feeding meningeal arteries with Onyx. This lead to radioanatomic cure in all but sixth patients. In the completely obliterated we observed that during this single feeder injection of Onyx 20 or 34 led to penetration to the origin of the first draining vein at the tentorial or falcine sinus and could then, with continued injection, retrogradely penetrate into the distal parts of the other feeding arteries leading to complete arterial disconnection from the venous side. In two patients for safety reasons to block retrograde embolisation of the internal carotid artery via the artery of Bernasconi, the internal carotid artery was temporarily blocked with a balloon at the origin of this branch during injection. One patient primarily and 3 others were then successfully occluded by surgery, the remaining by an endovascular transvenous approach with injection of Onyx. No lethal or complications with persistent disabling morbidity were recorded.DisclosuresH. Nahser: 6; C; Support for Travel to meetings by various companies. M. Puthuran: 6; C; Support for Travel by various companies. A. Chandran: None. M. Javadpour: 6; C; Support for Travel to meetings by various companies. P. Eldridge: 6; C; support for Travel to meetings by various companies.
O-002 Initial Clinical Experience with the ADAPT technique: A Direct Aspiration first Pass Technique for Stroke Thrombectomy
Authors: Turk A , Spiotta A , Frei D , Mocco J , Baxter B , Siddiqui A , Mokin M , Dewan M , Turner R , Hawk H , Miranpuri B , Chaudry I 
Published: July 2013

BackgroundThe development of new revascularisation devices has improved recanalisation rates and time, but not clinical outcomes. We report our initial results with a new technique utilising a direct aspiration first pass technique with large bore aspiration catheter as the primary method for vessel recanalisation.MethodsA retrospective chart review of 18 patients at 5 institutions was performed on patients where the ADAPT technique was utilised. The data represents the initial experience with this technique.ResultsThe ADAPT technique alone was successful in 2/3 cases, although 4 cases had large downstream emboli that required additional aspiration. Four cases required the additional use of a stent retriever and one case required the addition of a Penumbra aspiration separator to achieve recanalisation. The average time from groin puncture to at least TICI 2b recanalisation was 30 minutes and all cases were successfully revascularised. TICI 3 recanalisation was achieved 72% of the time. On average, patients presented with an admitting NIHSS of 16.4 and improved to NIHSS of 3.1 by the time of discharge. There were no procedural complications.DiscussionThis initial experience highlights the importance of the technique with which new stroke thrombectomy devices are used may be as crucial as the device itself. The ADAPT technique is a simple cost effective method that is leading us to re-think our approach to acute ischaemic stroke thrombectomy by simply utilising the latest generation of large bore aspiration catheters independently to achieve excellent angiographic and clinical outcomes.DisclosuresA. Turk: 1; C; Penumbra, Covidien, Microvention. A. Spiotta: None. D. Frei: None. J. Mocco: None. B. Baxter: None. A. Siddiqui: None. M. Mokin: None. M. Dewan: None. R. Turner: None. H. Hawk: None. B. Miranpuri: None. I. Chaudry: 1; C; Penumbra, Covidien, Microvention.
O-022 Perfusion-based selection leads to improved outcomes compared with time-based selection for endovascular reperfusion therapy in acute ischaemic stroke
Authors: Soltanolkotabi M , Prabhakaran S , Shaibani A , Hurley M , Curran Y , Conners J , Lee V , Ansari S 
Published: July 2013

BackgroundControversy exists on the role of perfusion imaging-based selection of patients with acute ischaemic stroke (AIS) for endovascular reperfusion therapy (ERT). Our hypothesis was that perfusion imaging based selection would improve functional outcomes at 3 months compared to time based selection alone.MethodsWe reviewed data from consecutive AIS patients treated with ERT at 4 centres between 2006 and 2011. We excluded patients with initial NIHSS score < 8 and those with posterior circulation occlusions. We collected data on demographics, initial NIHSS score, intravenous tissue plasminogen activator (IV tPA), use of perfusion imaging (CT or MRI), time from onset to groin puncture, initial and final reperfusion grade using the modified TICI scale, procedural complications using ECASS criteria, and functional outcome defined as modified Rankin Scale (mRS) 0–2 at 3 months. Using univariable statistics and multivariable logistic regression, we assessed whether patients who underwent perfusion imaging had better outcomes than those selected based on time alone. We estimated odds ratios (OR) and 95% confidence intervals (CI) in the final model.ResultsOne-hundred eighty-five patients (mean age 66.7 years; median NIHSS score 19; MCA occlusion 73% and ICA occlusion 27%) were included. TICI 2b or 3 reperfusion grade was achieved in 49.7% while symptomatic haemorrhage (PH1, PH2, or perforation) occurred in 10.8%. Good outcome at 3 months was seen in 41.7%. Perfusion imaging was used in 69 (37.3%) patients (45 CT and 24 MRI) and was associated with increased onset-to-groin puncture time (359 vs 298 minutes, P=0.019). Patients who underwent perfusion imaging were also older (73 vs 63 years, P<0.001). Those who underwent perfusion imaging were more likely to have good outcome (53.6 vs 34.5%, P=0.011). In multivariable analysis, perfusion imaging remained a predictor of good outcome (adj. OR 2.35, 95% CI 1.17-4.72), independent of initial NIHSS score (adj. OR 0.91, 95% CI 0.86-0.97), TICI 2b or 3 reperfusion (adj. OR 4.94, 95 CI 2.50-9.76), and IV tPA use (adj. OR 2.50, 95% CI 1.26-4.94).ConclusionsIn this multi-centre study, AIS patients who underwent perfusion imaging were over 2-fold more likely to have good outcome following ERT despite a delay in time to treatment and age imbalance between groups. Further studies should continue to address the optimal perfusion imaging thresholds for patient selection for ERT.DisclosuresM. Soltanolkotabi: None. S. Prabhakaran: None. A. Shaibani: None. M. Hurley: None. Y. Curran: None. J. Conners: None. V. Lee: None. S. Ansari: None.
O-026 Does Transfer Status Affect Outcomes in Acute Ischaemic Stroke Patients Treated Endovascularly?
Authors: Soltanolkotabi M , Shaibani A , Hurley M , Prabhakaran S , Lee V , Conners J , Ansari S 
Published: July 2013

BackgroundAccess to intra-arterial therapy (IAT) for acute ischaemic stroke (AIS) is limited to comprehensive stroke centres (CSCs) with timely access deemed critical for success. Inter-hospital transfers represent a growing subset of patients in which outcomes have not been well-studied.Design/MethodsWe retrospectively analysed consecutive anterior circulation AIS patients that underwent IAT at 4 institutions from2006–2011. We excluded patients selected using perfusion imaging. Patient demographics, medical risk factors, presentations, technical, and clinical (NIHSS and mRS scores) outcomes, complications, and mortality were studied. Symptom-onset, groin puncture, and end-of-procedure times were recorded. THRIVE scores were calculated. Successful recanalisation was defined as TIC I≥2b. Good functional outcome was defined as mRS 0–2 at 90 days. Patients were categorised into those who were transferred from outside institutions and those who presented directly to the CSCs.Results116 patients were studied. 68 (58.6%) were transferred from outside institutions. Transfers and non-transfers were similar in THRIVE scores (p=0.300), median symptom-onset to groin puncture times (306 vs 315 minutes; p=0.572), successful recanalisation (p=0.574), and symptomatic IC H (13.2 vs 10.4, p=0.776), but differed by age (59 vs 69 years; p=0.002), prior stroke (3% vs 22%, p=0.002), cardiac history (17.9 vs 36.6%, p=0.040), baseline NIHSS (20 vs 17, p=0.005), and location of occlusion (45.6% vs 22.9% IC A, p=0.012). Transfer patients had significantly worse outcomes at 90 days (mRS 0–2: 16.2% vs 60.4%, p>0.001). In multivariate analysis, transfer status was an independent predictor of poor functional outcome (adj. OR 0.05, 0.011 0.222), adjusting for relevant covariates.ConclusionsTransferred AIS patients have worse functional outcomes at 90 days than non-transfers, independent of baseline risk factors, stroke severity, time to IAT, and procedural success/complications. Further investigation should focus on residual factors that may contribute to our findings such as baseline/final infarct volumes, pre-morbid functional status, and post-stroke care.DisclosuresM. Soltanolkotabi: None. A. Shaibani: None. M. Hurley: None. S. Prabhakaran: None. V. Lee: None. J. Conners: None. S. Ansari: None.
P-003 Intracranial Aneurysms in the Youngest Patients: Characteristics and Treatment Challenges
Authors: Gross B , Smith E , Scott R , Orbach D 
Published: July 2013

BackgroundPaediatric intracranial aneurysms have been reviewed in several recent series. These series have included patients up to ages 15–18. However, the characteristics and treatment challenges of aneurysms in young children differ from those in teenagers. As such, we focused on the cohort of children age 10 and under who presented with intracranial aneurysms, and discuss subtypes, presentation, treatment strategies, and outcomes.MethodsWith approval from the Boston Children’s Hospital Institutional Review Board, the records of children undergoing cerebral or spinal angiography by the senior author (DBO) from October 2006–June 2012 were reviewed to identify patients aged 10 and under who presented with intracranial aneurysm. Presentation, subtype of aneurysm, treatment strategy, and outcome were evaluated.ResultsOf 592 paediatric cases reviewed, 27 were for paediatric patients up to age 17 harbouring cerebral aneurysms (4.6%), and 15 occurred in children 10 years of age and younger (2.5%), with a mean age at presentation of 5.1 years (range, 3 months - 10 years). Of these fifteen children, 4 had characteristics of arterial dissection, 3 had angiographic characteristics of pseudoaneurysm (with all three having a history of prior microsurgery for tumour), 4 were fusiform, 3 were saccular (with 1/3 in a patient with PHACES and Moyamoya), and 1 was mycotic. Six patients underwent endovascular treatment, 1 underwent combined microsurgical and endovascular repair and 4 underwent microsurgical repair. Four patients have not been treated and are under current observation. One patient expired due to complications related to prior attempted aneurysm treatment at an outside facility, 1 patient expired from complications related to his malignant brain tumour, and 1 patient experienced complications related to attempted microsurgical repair; the other 11 patients are intact or have neurological compromise related to their initial presentation.ConclusionsPrevious investigations, including patients from birth to late teenage years, have documented unique characteristics of paediatric aneurysms relative to adults. We demonstrate that the youngest patients, those age 10 years and under, have aneurysms even more distinct than those in the larger paediatric cohort. These patients present unique treatment challenges.DisclosuresB. Gross: None. E. Smith: None. R. Scott: None. D. Orbach: None.
P-014 Initial Experience with RF Ablation and Vertebral Augmentation in Spinal Neoplasms
Authors: Rutledge J , Conrad K , Parker M 
Published: July 2013

IntroductionOver 1.5M patients are diagnosed annually with cancer in the United States. (Noone) The spine is the most common site of bone metastasis. Over 60% of spinal metastases are symptomatic (Maccauro) and often limit a patient’s ability to cooperate for radiation or chemotherapy. Although radiofrequency (RF) ablation has proven effective in providing palliative relief, the unique anatomy of the spine has resulted in limited adoption of RF ablation of such lesions.MethodsA retrospective analysis was performed of 39 procedures in 27 patients with a wide variety of spinal neoplasms and secondary painful compression fractures which limited their ability to undergo conventional chemotherapy and radiation. Targeted RF ablation (t-RFA) followed by cement augmentation was performed via a minimally invasive coaxial system. An innovative RF ablation system (STAR) consisting of a robust articulating, navigational bipolar electrode containing two active thermocouples (TCs) permitted real time monitoring to determine the size of the ablations. Access and number of ablations were based on lesion size and location, and ability to articulate the bipolar electrode. Cement augmentation via the same guiding cannula was performed once physiologic temperature was confirmed.Results39 levels from T4 to S3 were treated successfully with RF ablation and vertebral augmentation without complication. Articulation of the ablation device enabled access to lesions throughout the vertebral bodies. Ablation zones were successfully controlled by monitoring TC temperature in-situ and, when necessary, adjusting power. No thermal injury occurred. Cement augmentation following t-RFA was efficient and resulted in a predictable filling. Pain control was rapidly achieved in all patients allowing them to restart chemotherapy or radiation therapy. One patient required addition RF ablation and vertebral augmentation at adjacent levels as his disease progressed and pain recurred.ConclusionOur initial clinical experience shows that targeted RF ablation using a novel articulating ablation technology, combined with vertebral augmentation, provides a safe method of stabilisation and pain control allowing patients who otherwise would be unable, to continue with conventional cancer therapy.DisclosuresJ. Rutledge: None. K. Conrad: None. M. Parker: None.
P-017 Balloon-Assisted Guide Catheter Positioning to Overcome Extreme Cervical Carotid Tortuosity: Technique and Case Experience
Authors: Fiorella D , Peeling L 
Published: July 2013

Background and SignificanceWe describe a method by which to efficiently and atraumatically achieve distal positioning of a flexible guiding catheter beyond extreme cervical tortuosity using a hypercompliant temporary occlusion balloon.MethodsA retrospective review of a prospective neuroendovascular database was used to identify cases in which a hypercompliant balloon catheter (Hyperform or Hyperglide, ev3/Covidien, Irvine, CA; Scepter or Scepter XC, MicroVention, Tustin, CA) was used to achieve distal positioning of a flexible guiding catheter (Navion, ev3/Covidien, Irvine, CA; Neuron, Penumbra Inc., Alameda, CA). After achieving a stable guiding sheath position within the proximal cervical carotid artery, a hypercompliant balloon catheter was manipulated beyond the tortuous cervical internal carotid segment into the distal carotid artery. The balloon was then inflated to anchor it distally within the cavernous segment of the ICA. Then the guiding catheter was advanced beyond the tortuous cervical segment, over the balloon catheter, as gentle counter traction was applied to the balloon.ResultsBalloon-assisted guiding catheter placement was used to perform endovascular treatments of twelve anterior circulation aneurysms. One patient underwent coiling alone. Five patients underwent balloon assisted coiling. One patient underwent balloon and stent assisted coil embolisation. Four patients with five carotid aneurysms (one with bilateral carotid aneurysms) underwent vascular reconstruction with the pipeline embolisation device. All patients had tortuosity of the carotid system. Three patients had findings consistent with cervical carotid fibromuscular dysplasia. The technique was successful each time it was attempted. No parent artery dissections or catheter-induced vasospasm were noted in any case.DiscussionHypercompliant balloon catheters can be reliably used to facilitate safe and rapid distal positioning of flexible guiding catheters beyond severe cervical tortuosisty.DisclosuresD. Fiorella: 1; C; MicroVention, Siemens Med Systems. 2; C; ev3/Covidien, JNJ/Codman, CVSL. 6; C; Codman. L. Peeling: None
P-020 Preliminary Findings of Recanalisation and Stenting for Symptomatic Vertebrobasilar Artery Occlusion Lasting more than 24 hours: A Retrospective Analysis of 21 Cases
Authors: He Y , Wang Z , Li T 
Published: July 2013

Introduction and PurposeA subset of patients with vertebrobasilar artery occlusion (VBAO) lasting more than 24 hours still suffered recurrent ischaemic events and progressive disability despite intensive medical therapy. The prognosis of these patients is extremely poor, with a high incidence of catastrophic brainstem and cerebellar infarction. Optimal management for these patients remains unknown. Recurrent symptoms despite aggressive medical treatment may be an indication for endovascular revascularisation and stenting. This study was to evaluate the technical feasibility, safety and short-term effects of recanalisation and stenting.Materials and MethodsTwenty-one consecutive patients with VBAO including 12 vertebral artery occlusion (VAO: occlusion not involving basilar artery) and 9 basilar artery occlusion (BAO) lasting more than 24 hours refractory to aggressive medical treatment were enrolled into this study and underwent recanalisation and stenting between February 2010 and November 2011. Data were retrospectively collected. The rate of recanalisation was evaluated radiographically and the functional outcome was examined using modified Rankin Scale (mRS) scores. Independent groups T-test, t’-test, Fisher Exact test or Nonparametric test were used according to the studied variables characteristics.ResultsThe median time between onset of symptoms and recanalisation was 1.7 months (IR, 0.9–5.2), and the median time between imaging-documented occlusion and endovascular recanalisation was 10.5 days (IR, Interquartile Range: 6.5–18); Median NIH Stroke Scale (NIHSS) at admission was 8 (IR, 2–13). Technique success ratio of recanalisation was 95.2%. There were 3 periprocedural complications. Median mRS score was 4 (IR, 2.5–5) prior to procedure and 4 (IR, 1–5) at discharge (P<0.05). One stroke and one death occurred within 30 days postprocedure. Mean duration of clinical follow-up was 6.9 months. One transient ischaemic attack, one stroke and one death occurred beyond 30-day postprocedure. Mean angiographic follow-up was 8.9 months in 7 patients. Three patients developed in-stent restenosis or occlusion, and two of them were symptomatic. Subgroup analyses revealed patients got better functional recovery (lower mRS) at discharge in patients with VAO (P<0.05) compared with their respective preoperative mRS scores and there was no significant difference in patients with BAO.ConclusionsEndovascular recanalisation and stenting for symptomatic VBAO lasting more than 24 hours was technically feasible and patients with VAO benefited from the treatment with significant functional recovery. However, the complexity of the procedure and high risk of complications should prompt extreme caution. Procedures should only be performed at high volume centres by experienced operators.DisclosuresY. He: 1; C; Zhengzhou University. Z. Wang: None. T. Li: None.
P-021 Should Ischaemic Stroke Patients with Aphasia or High NIHSS Score Undergo Pre-procedural Intubation Prior to Endovascular Treatment?
Authors: Hassan A , Adil M , Tekle W , Qureshi A 
Published: July 2013

Background and purposePresence of aphasia or severe neurological deficits is considered an indication for pre-procedural intubation (PPI) for endovascular treatment (ET) of acute ischaemic stroke (AIS) patients although a critical analysis has not been performed. To compare outcomes in AIS patients undergoing ET with or without PPI in two groups of patients: those with presence of aphasia; and those with admission NIHSS score of ≥20.MethodsAll endovascular treated AIS patients were identified through a database maintained from two comprehensive stroke centres over an 8 year period. The rate of intra-procedural intubation in patients without PPI was ascertained. The rates of poor functional outcome at discharge (modified Rankin score [mRS] of ≥3) and intracerebral haemorrhage (ICH) were compared between those who did or did not undergo PPI in the two study groups.ResultsIn the first analysis, 60 (50%) of 120 patients with aphasia underwent procedure without PPI; 6 of 60 patients required intra-procedural intubation. The odds of any ICH [OR 6.3, 95% CI 1.6–24.0] and in-hospital mortality [OR 9.3, 95% CI 2.7–31.0] were significantly higher among those who underwent PPI after adjusting for potential confounders. In the second analysis, 36 (39%) of 93 patients with NIHSS score ≥20 underwent ET without PPI; 6 of 57 patients required intra-procedural intubation. The risk of any ICH (OR 7.6, 95% CI 0.9–67.8) and in-hospital mortality [OR 5.0, 95% CI 0.9–27.5] were higher among patients who underwent PPI, after adjusting for potential confounders. The rates of good outcome at discharge were significantly lower among those patients with aphasia [OR 0.1, 95% CI 0.04–0.2, p=<0.0001] or those with NIHSS score ≥20 [OR 0.07, 95% CI 0.005–0.9, p=0.04] who underwent PPI.ConclusionsDespite the risk of intra-procedural intubation among patients with either aphasia or admission NIHSS score ≥20 who undergo ET without PPI, the rates of poor outcomes, ICH, and death are prominently lower than those with PPI.DisclosuresA. Hassan: None. M. Adil: None. W. Tekle: None. A. Qureshi: None.