bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-039 Safety and Efficacy of Flow Diverter Treatment for Carotid-Ophthalmic Aneurysms
Authors: Grossberg J , Tong F , Cawley C , Dion J 
Published: July 2014

Introduction/purposeThe purpose of this study was to determine the efficacy and safety of flow diversion technology in the treatment of aneurysms of carotid-ophthalmic aneurysms.Materials and methodsThis study retrospectively reviewed outcomes in 45 consecutive patients with carotid-ophthalmic aneurysms who were treated with Pipeline Embolization Device (PED) by three separate neuro-interventionalists. A chart review was performed to collect information on demographics, aneurysm size, treatment outcomes, and procedure-related complications. The primary end-points were rate of aneurysm occlusion and ophthalmic artery patency, as assessed by angiographic images. The secondary end point was peri- and post-procedural complications were evaluated. Descriptive statistical analysis was performed.ResultsThere were 39 females and 6 males in the study. The average age was 56.4 (range 31–81). Thirty-two patients had a single aneurysm treated during the PED procedure; multiple aneurysms were treated in 13 cases. All of the aneurysms treated were unruptured. Seven aneurysms were recurrences of prior coil embolization procedures. The average aneurysm size was 8.9 mm (range 2.1–26). The treated aneurysm measured <10 mm in 28 cases. The average neck size was 5.3 mm (range 1.6–9.3 mm). Patients were treated with one PED in 32 cases, two PEDs in 10 cases, three PEDs in 2 cases, and four PEDs in 1 case. Eleven cases were treated with coiling in addition to PED placement.The PED was successfully deployed in 44 of 45 cases. There were two mortalities (4.4%) within 30 days of treatment-one from a large intraparenchymal haemorrhage and one from unknown causes. Other 30-day complications included capture coil fracture (2), reversible intra-procedural thrombosis (2), small contralateral convexity subarachnoid haemorrhage (1), and symptomatic embolic infarcts (1). There were no complications seen after 30 days.Six month angiographic follow-up was available in 37. There was complete aneurysm occlusion in 27 patients (73%). There was minimal residual aneurysm filling in eight patients (22%) and only slightly decreased aneurysm filling in two patients (5%). There was only one instance (3%) of ophthalmic artery occlusion noted, and this was asymptomatic.ConclusionFlow diversion treatment for carotid-ophthalmic aneurysms has a high rate of aneurysm occlusion, while maintaining a low complication rate.DisclosuresJ. Grossberg: None. F. Tong: None. C. Cawley: None. J. Dion: None.
E-041 Use of Flow Diverters in the Endovascular Reconstruction of Fusiform Dissecting Vertebral Artery Aneurysms
Authors: Puri A , Massari F , Hou S , Perras M , Brooks C , Stout C , Gounis M , Wakhloo A 
Published: July 2014

Introduction/purposeFusiform aneurysms (FUANs) of vertebral artery are difficult to treat by using current surgical techniques. Endovascular techniques like parent vessel occlusion, trapping, coiling, stent assisted coiling or stent mono-therapy is currently used to treat these aneurysms. The purpose of this study is to assess the efficacy and safety of flow diverters (Pipeline Embolization Device) in the treatment of vertebral artery FUANs compared to currently used therapeutic modalities.Materials and methodsFrom July 2012 to October 2013, a total of 5 vertebral artery fusiform dissecting aneurysms in 5 patients (2 men and 3 women; age range, 39–59 years; mean age, 50.8 years) were treated with pipeline embolization device (PED) at our institution. In 2 patients the aneurysms were an incidental finding whereas in the other 3 cases were associated to neurologic symptoms, such as visual changes, ataxia, facial numbness or vertigo. Location of the aneurysms was as follows: 4 aneurysms on the right and 1 on the left side. 4 aneurysms were centerd at the V4 segment of the vertebral artery (intradural); only one was located at the vertebral V3-V4 segments junction (intra/extradural). Only one patient had family history indicative for intracranial aneurysm. Aneurysms ranged from 5 to 13 mm in maximal diameter. The technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcome were evaluated.ResultsIn every case, endovascular treatment was achieved. Immediate angiography demonstrated intra-aneurysmal contrast stagnation, with parent artery preservation in all cases. Major procedure-related complications were not observed. A brief temporary episode of dysarthria was noted in one of the patient. None of the treated aneurysms experienced bleeding or thrombo-embolic complication during the follow-up time. At 6 month follow-up (4 patients) was noted a complete/near complete aneurysm obliteration in 3 patients and partial obliteration in 1 patient. At 1 year follow-up (2 patients) was noted a progression to complete aneurysm obliteration in 1 patient and stable partial embolization in 1 patient. No intimal hyperplasia was noted at 6–12 months follow-up in the cohort of patients analyzed.ConclusionIn our preliminary experience vertebral artery fusiform dissecting aneurysms treatment with PED is a safe and efficacious option in treating dissecting or fusiform intracranial aneurysms. Long term studies and larger cohort is recommended for further evaluation of this treatment strategy.DisclosuresA. Puri: None. F. Massari: None. S. Hou: None. M. Perras: None. C. Brooks: None. C. Stout: None. M. Gounis: None. A. Wakhloo: None.
E-042 Use of Flow Diverters in Vessels less than 2.5 mm during Intracranial Aneurysm Treatment
Authors: Puri A , Massari F , Hou S , Perras M , Brooks C , Stout C , Gounis M , Wakhloo A 
Published: July 2014

Introduction/purposePipeline Embolization Device (PED) is currently indicated for treatment of large and complex intracranial aneurysms centerd along the cavernous/intradural segment of the internal carotid artery (ICA) proximal to the Posterior Communicating (PCom) artery. The purpose of this study is to assess the efficacy and safety of flow diversion treatment in unruptured complex aneurysms centerd along small vessel branches of the anterior and middle cerebral arteries.Materials and methodsFrom August 2013 to December 2013, a total of 3 intracranial aneurysms located along small vessel branches of the anterior circulation in 3 patients (1 man and 2 women; age range, 60–71 years; mean age, 64.6 years) were treated with pipeline embolization device (PED) at our institution. In 2 patients the aneurysms were incidentally found during cerebral angiogram exam performed for additional unruptured intracranial aneurysm treatment planning; in the other case the aneurysm was prior source of a subarachnoid haemorrhage (SAH). The parent vessel size ranged from 1.8 to 2.2 mm, mean 2 mm. Location of the aneurysms was as follows: 2 aneurysms centerd along the pericallosal artery (1 left, 1 right), branch of the anterior cerebral artery (ACA), and 1 aneurysm located on the right angular artery, branch of the middle cerebral artery (MCA). In the patient group no family history for intracranial aneurysm is reported. Aneurysms ranged from 2.5 to 3.7 mm in maximal diameter. The technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcome were evaluated. At 6 month follow-up (1 patient) was noted a complete right angular artery aneurysm obliteration, with mild in-PED intimal hyperplasia.ResultsIn every case, endovascular treatment was achieved. Immediate angiography demonstrated a intra-aneurysmal contrast stagnation, with parent artery preservation. No major or minor procedure-related complications were noticed. None of the treated aneurysms experienced bleeding or thrombo-embolic complication intra-, post procedurally or on follow-up.ConclusionAlthough the experience is limited by the small volume of cases treated with PED for unruptured complex aneurysms centerd along less than 2.5 mm vessel branches of the anterior circulation, the procedure was noted to be a feasible, safe and effective method to obtain aneurysm occlusion without parent vessel occlusion.DisclosuresA. Puri: None. F. Massari: None. S. Hou: None. M. Perras: None. C. Brooks: None. C. Stout: None. M. Gounis: None. A. Wakhloo: None.
E-044 A Multicenter Case Review Study to Assess Radiation Exposure (CARE) in the Treatment of Intracranial Aneurysms with the Penumbra Coil 400
Authors: Chowdhary A 
Published: July 2014

PurposeRadiation exposure during an angiographic procedure may present a significant health risk to patients. The goal of this multicenter case study (CARE) is to compare such exposure in patients treated with the novel Penumbra Coil 400™ System (PC 400) vs. conventional coils. The PC 400 coils are a new generation of platinum embolic coils designed specifically to enhance filling efficiency, which can allow faster procedure times. This could lead to less radiation exposure than with conventional coils in comparable size aneurysms.MethodsCARE will enrol up to 90 patients, including the control group, presenting with intracranial aneurysms at 15 centers in the USA. They will receive coil embolization therapy with the PC 400 or conventional coils (2:1) in accordance with the cleared indications for use. Adjunctive use of stents, balloons or liquid embolics is permitted. The primary endpoints are: 1) Acute radiation exposure at immediate post-procedure [air kerma, kerma-area product (KAP) or dose area product (DAP), and fluoroscopic time]; 2) Procedural serious adverse events up until 3 days or discharge, whichever occurs first.ResultsIt is predicted that patient enrollment will require 12 months. Patients will be monitored and assessed until 3 days after the coiling procedure or discharge from the hospital (whichever occurs first). IRB approval is pending for this study.ConclusionLimited literature is available about treatment-related radiation exposure in patients treated by the PC 400. We hypothesise that due to the unique large volume of these coils, procedural time for embolic coiling of intracranial aneurysms may be shortened over conventional coils, leading to significantly lower radiation exposure.DisclosuresA. Chowdhary: None.
E-051 Classification of Cavernous Internal Carotid Artery Tortuosity: A Predictor of Procedural Complexity in Pipeline Embolization
Authors: Uwandu C , Lin L , Colby G , Huang J , Tamargo R , Coon A 
Published: July 2014

BackgroundEndoluminal reconstruction of a diseased parent artery with flow diverters is increasingly used for the treatment of intracranial aneurysms. The complexity of these procedures can be highly variable. Understanding the degree of tortuosity of the cavernous internal carotid artery (ICA) may help predict procedural complexities of deploying flow diverters such as the Pipeline embolization device (PED).MethodsWe retrospectively reviewed a prospective, single-center aneurysm database to identify all patients with ICA aneurysms proximal to the posterior communicating artery who underwent endovascular treatment using the PED with the Navien distal intracranial guide catheter. Cavernous ICA (cICA) tortuosity was measured as a ratio between the height difference of the cICA anterior and posterior genus (D) to the sum of the angles of the anterior and posterior genus (AP). Identified patients were categorized into three groups based on cICA tortuosity. An analysis of variance regression was performed to detect differences among the three groups as they relate to procedural fluoroscopy time length, cICA tortuosity (D/AP), and aneurysm size.ResultsSeventy-eight cICA were analyzed and the degree of tortuosity was categorized into minimal (group I, n = 26), moderate (group II, n = 28), and severe or “Simmons-type” (group III, n = 24). The three groups were comparable with relation to patient age (mean group I – 55.5, II – 55.0, III – 55.9) and aneurysm size (mean group I – 6.2 mm, II – 7.8 mm, III – 9.0 mm). Analysis of variance demonstrated significant differences in procedural fluoroscopy time (FT) and degree of cICA tortuosity (D/AP). Mean FT was greater in group III (50.3 + 13.5) compared to group II (42.3 + 33.3) and group I (30 + 8.4), p value <0.005. Similarly, mean D/AP was significantly higher in group III (0.49 + 0.38) compared to groups II (0.14 + 0.07) and I (0.008 + 0.0008), p value <0.005. In group I, PED deployment was successful in 100% of cases whereas groups II and III had 2 and 1 unsuccessful cases respectively.ConclusionIn this study, we propose a classification system for cICA tortuosity based on measurements of the anterior and posterior genu geometry. This classification correlates strongly with markers of PED procedural complexity and may be helpful in pre-procedure prognostication.DisclosuresC. Uwandu: None. L. Lin: None. G. Colby: None. J. Huang: None. R. Tamargo: None. A. Coon: 2; C; ALC is a proctor for the Pipeline Embolization Device (Covidien, Mansfield, Massachusetts, USA) and a consultant for Covidien.
O-012 Demographic and Lesion Characteristics Outperform Degree of Stenosis in Predicting Outcomes Following Stenting for Symptomatic Intracranial Atherosclerosis
Authors: Alexander M , Cooke D , Meyers P , Amans M , Narvid J , Dowd C , Halbach V , Higashida R , Hetts S 
Published: July 2014

IntroductionIntracranial atherosclerotic disease (ICAD) is often stratified by degree of stenosis. Additional features such as patient demographics and symptom characteristics also affect lesion behavior and response to treatment. This study compares stratification by degree of narrowing to these additional features.Materials and methodsRetrospective analysis was performed on patients at 4 hospitals with ICAD causing stroke or transient ischemic attack (TIA) treated with stents. Patient demographics, lesion features, symptom characteristics, treatment success, and post-treatment outcomes such as technical complication, transient ischemic attack, stroke, or death were noted. Symptom characteristics were divided by aetiology as hypoperfusion, non-hypoperfusion, or indeterminate. Univariate logistic regression was performed for nominal variable types, and decision trees were constructed using recursive partitioning for continuous variables.ResultsChi-square univariate logistic regression analysis demonstrated significant correlation of female gender with stroke at 30 days (x2[1, n = 130] = 5.106, p = 0.024). At point of last clinical contact, TIA was associated with an indeterminate symptom aetiology as opposed to identifiable hypoperfusion or non-hypoperfusion aetiology (x2 [1, n = 130] = 5.556, p = 0.018), as was initial presentation with TIA rather than stroke (x2[1, n = 130] = 6.458, p = 0.011). When comparing non-hypoperfusion and indeterminate symptom etiologies against clearly identifiable hypoperfusion aetiology, the non-hypoperfusion group was more likely to have a stroke by point of last contact (x2[1, n = 130] = 7.664, p = 0.006). Stroke outcome was also associated with lesion stenosis >95% (x2[1, n = 130] = 5.709, p = 0.017). Recursive partitioning analysis confirmed the above-described results and identified age >76.6 years as associated with symptomatic technical complications (x2[1, n = 130] = 0.047).ConclusionDegree of atherosclerotic stenosis is commonly used to stratify lesions when assessing suitability for treatment. This study identified stronger prognostic value in lesion features, specifically pathophysiologic features of presenting symptoms, and patient age and sex. Further research is needed to develop more robust models to predict natural history and potential response to endovascular treatment for ICAD.DisclosuresM. Alexander: None. D. Cooke: None. P. Meyers: None. M. Amans: None. J. Narvid: None. C. Dowd: None. V. Halbach: None. R. Higashida: None. S. Hetts: None.
E-055 Incidence of External Ventricular Drainage Placement on Rebleeding of Ventricular Arteriovenous Malformations
Authors: Robert T , Blanc R , Gilboa B , Ciccio G , Fahed R , Redjem H , Pistocchi S , Bartolini B , Piotin M 
Published: July 2014

BackgroundIntraventricular arteriovenous malformation (AVM) is an exceptional but well recognised source of intraventricular haemorrhage. The impact of external ventricular drainage (EVD) for acute hydrocephalus on AVM rebleeding has not been yet reported in the literature.MethodsSince 1995, clinical and angiographic data of cerebral AVMs were prospectively collected. In this study, we selected patients harbouring an AVM located in a lateral ventricle discovered by a bleeding. The implication of following factors on rebleeding was analyzed: age, sex, associated aneurysm, nidus size and type, venous ectasia, Spetzler-Martin grade, placement of EVD and side of the drainage.ResultsTwenty-two patients (mean age 27.9 years) were consecutively treated. Locations of the AVM included the atrium in 13 cases (59.1%), the frontal horn in 12 cases (54.6%) and the occipital horn in 2 cases (9.1%). 9 AVMs (40.9%) interested eloquent areas. The Spetzler-Martin grade was II in 10 cases (45.5%), III in 3 (13.6%), IV in 8 (36.4%) and V in 1 case (4.5%). Associated aneurysms were classified as nidal (2 cases, 9.1%), flow-related (2 cases, 9.1%) and unrelated to the AVM (3 cases, 13.6%). Ten (45.5%) patients developed a secondary hydrocephalus. Five EVD were placed in the ventricle of the AVM and the five other in the contralateral ventricle. The placement of the shunt in the contralateral ventricle was a significant risk factor AVM rebleeding (95% CI: 4.33–10.42, p < 0.005). The presence of an associated aneurysm, diffuse type of the nidus and the placement of EVD seemed to be risk factors for the rebleeding of the AVM.ConclusionsThe placement of EVD in the opposite side of the AVM significantly increased the risk of rebleeding of the AVM. We recommend the placement of EVD in the side of the AVM even if the obturation of the shunt could be problematic also as the avoidance of the nidus by the catheter.DisclosuresT. Robert: None. R. Blanc: None. B. Gilboa: None. G. Ciccio: None. R. Fahed: None. H. Redjem: None. S. Pistocchi: None. B. Bartolini: None. M. Piotin: None.
E-056 Pipeline Endovascular Device for the Treatment of Intracranial Aneurysm at the Level of the Circle of Willis and Beyond: Multicenter Experience
Authors: Martínez-Galdámez M , Linfante I , Lin E , Dabus G 
Published: July 2014

Background and purposeThe aim of our study was to evaluate the safety and eficacy of the Pipeline endovascular device for the treatment of anterior circulation aneurysms at the level of circle of Willis and beyond.MethodsA consecutive series of 23 patients with unruptured and 1 with ruptured anterior circulation aneurysms treated with Pipeline endovascular device. Complication rates, aneurysm obliteration, modified Rankin Scale (mRS) outcomes were assessed.ResultsAll devices were placed properly, without technical difficulties.We found 1 minor clinical event (resolved within 7 days from procedure) and 1 major event (symptoms present after 7 days) (table), and no mortality.There were no aneurysm rupture or parenchymal haemorrhage during follow-up.The mRS at 3 and 6 months did not change from prior mRS in all cases but 1.We had 2 asymptomatic periprocedural ischemic events: 1 perforator stroke in the case of a recanalised A1-A2 where we used 2 PEDs, and 1 lacunar stroke. Both cases were discovered incidentally at the control CT predischarge.We had 3 intraprocedural complications, resolved without clinical consequences:1 acute branch occlusion during hypotension state which was solved after TA raise (case 4), 1 slow opacification of the inferior trunk of MCA resolved with intraarterial bolus of reopro (case 20), and 1 focal SAH secondary to distal perforation with the microwire during and exchange manoeuvre which was resolved with coil occlusion and glue at the level of the perforation, with no symptoms (case 14)Six-month follow-up angiograms were obtained in 16 aneurysms, showing complete occlusion in 9 and significantly decreased residual filling in 7.5 cases are still pending on 6 months DSA and 1 case showed residual filling at the 3 months follow-up.Patency of PEDs and status of branches originating from the aneurysm sacs were evaluated in 17 and 11 angiograms respectively.All PEDs were patent, but we found 4 intrastent stenosis at 6 months DSA where only 1 symptomatic case (an angioplasty was done successfully).In the 11 branches evaluated, 7 were patent, 2 moderate reduced and in 2 cases were occluded asymptomatically.ConclusionThe PED provides a safe and effective solution for aneurysms at and beyond the circle of Willis. Preliminary results are promising but larger series with longer-term follow-up examinations are required to show the long-term safety and durability of this treatment alternative.DisclosuresM. Martínez-Galdámez: 2; C; Covidien. I. Linfante: 2; C; Covidien, Stryker, Codman. E. Lin: None. G. Dabus: 2; C; Covidien, Microvention, Reverse Medical.
E-062 Intracranial Stenting for Atherosclerotic Disease with Aggressive Anti-platelet Therapy Management: A Consecutive Series of 154 Patients
Authors: Alexander M , Nuno M , Alexander J , Agutos C , Yu W 
Published: July 2014

IntroductionContemporary studies of intracranial stenting have utilised standard or aggressive medical therapy involving dual anti-platelet therapy, but have not evaluated anti-platelet therapy resistance as a component of treatment failure.MethodsThe current study evaluates a prospective aggressive anti-platelet therapy management approach at two institutions in a consecutive series of 154 patients with symptomatic intracranial atherosclerotic disease (ICAD) treated with angioplasty and stenting with the Wingspan self-expanding nitinol stent. Anti-platelet medication therapeutic effects of aspirin and clopidogrel were measured prior to the procedures by platelet function assay, thromboelastography, aggregometry, or Accumetrics VerifyNow systems. Medications were adjusted or changed for subtherapeutic or supratherapeutic values with clopidogrel goal inhibition of 20–80% and aspirin reactive unit (ARU) less than 550.ResultsA total of 154 patients with symptomatic ICAD were treated from 2005 to 2014. The periprocedural complication rate was 3.9% (6/154) with 1 subarachnoid haemorrhage, 0 intraparenchymal haemorrhages, 5 perforator strokes, and no stent thrombosis. With a mean follow up of 2.3 years, the total ipsilateral stroke and death rate was 6.5% (10/154). The relative aspirin resistance rate was 7.8% and the relative clopidogrel resistance rate was 14.9% in this series. Eight of the patients (5.2%) required repeat angioplasty for symptomatic re-stenosis within the first year. The mean time to treatment was 10.7 days following the last stroke.ConclusionsWith aggressive monitoring and management of anti-platelet medications, intracranial stenting complications of stent thrombosis and distal emboli can be reduced, although there is still a significant risk of perforator strokes, particularly in the middle cerebral artery and basilar distributions.DisclosuresM. Alexander: 1; C; Stryker Neurovascular. M. Nuno: None. J. Alexander: None. C. Agutos: None. W. Yu: 1; C; Stryker Neurovascular.
O-013 How Tough is the Interventional Life, the Heart Rate of a Neurointerventionalist
Authors: Brouwer P 
Published: July 2014

Performing neurointerventional procedures can in some cases be considered demanding. Some procedures are straightforward but we all face situations where our heart rate and blood pressure seem to rise considerably.In this presentation a graphic representation will be given of the operators’ monitored heart rate during a variety of illustrative procedures.DisclosuresP. Brouwer: None.