bluuebunny/crossref_metadata_2025_split huggingface dataset:
O-029 Results of prospective randomly allocated trial of novel acute thrombectomy device in a swine model of stroke
Authors: Mocco J 
Published: July 2012

IntroductionWe present the initial results evaluating a novel stroke thrombectomy device in a swine model of thromboembolic stroke. This new technology, termed the ReCover, maintains a number of critical advances in acute stroke thrombectomy, including improved clot grip and a novel proprietary distal embolic protection system.MethodsTwo swine were prepared for multiple separate targeted vessel clot extractions with either a Solitaire or the new ReCover. A total of 19 appropriate vessels were identified across two animals. Random allocation was used to identify which particular device was to be used in each vessel, prior to clot injection. After each attempted thrombectomy the target vessel was graded for successful TIMI recanalization.ResultsBoth the Solitaire and ReCover thrombectomy devices were successful the majority of times. However, the ReCover achieved TIMI III recanalization eleven out of eleven times, whereas the Solitaire achieved TIMI III recanalization four out of eight times (p<0.05).ConclusionWe present the results of a prospective randomly allocated animal stroke model demonstrating a high success rate of the new thrombectomy technology.Competing interestsJ Mocco: Edge Therapeutics, Nfocus, Lazarus Effect. Blockade Medical.
O-032 Current trends in endovascular management of traumatic cerebrovascular injury: Abstract O-032 Table 1
Authors: Kansagra A , English J , Sincic R , Hetts S 
Published: July 2012

PurposeThe role of catheter angiography in diagnosis and management of traumatic cerebrovascular injury has evolved dramatically due to increased adoption of CT and MR angiography and continued refinement of endovascular techniques. The purpose of this study was to identify the modern spectrum of cerebrovascular injury encountered during catheter angiography in the setting of trauma and to examine current patterns of endovascular treatment.MethodsRecords of patients undergoing catheter angiography for traumatic craniocervical arterial injury over a 4-year period at a Level 1 trauma center and a quaternary referral center were retrospectively reviewed. Patients without known trauma mechanism were excluded. The sample comprised 100 separate arterial lesions distributed among 39 males and 13 females (mean age 36 years); all patients had antecedent CT or MRI. Injuries were classified according to mechanism, location, type, acuity, and endovascular treatment. Follow-up-imaging and clinical notes were reviewed to identify delayed complications.ResultsOf 100 arterial lesions, 81% were related to blunt force trauma. Distribution of lesions by location was 39% cervical, 42% intracranial, and 19% extracranial. The most common injuries were pseudoaneurysm (37%), fistula (29%), and dissection (19%). In total, 41% of lesions underwent endovascular treatment; endovascular treatment rate was 24/71 (34%) for lesions less than 14 days old and 17/29 (59%) for older injuries. Therapy involved coil embolization for 36 (88%) lesions; stents were used as part of treatment for only 8 (20%) lesions. There were a total of 3 (7.3%) immediate neurovascular complications (infarct, intracranial hemorrhage, iatrogenic dissection) resulting in 1 (2.4%) permanent neurologic deficit. No delayed neurovascular complications occurred over a mean period of follow-up of 4.9 months (range 0–30 months), regardless of whether endovascular therapy was undertaken.ConclusionStrategies for treatment of traumatic cerebrovascular injury continue to evolve. Our recent experience in a large cohort of patients suggests that a relatively high proportion of traumatic arterial lesions identified during catheter angiography are treated by endovascular means, with a low rate of immediate and delayed neurovascular complications.Competing interestsNone.Abstract O-032 Table 1Endovascular treatment based on injury typeTreatment typeDissectionThrombusPseudoaneurysmOcclusionTransectionFistulaAneurysm ruptureTotalUntreated172151420059Coil embolization0014157128Coil embolization (stent-assisted)00500005Liquid embolization00200002Coil and liquid embolization00100203Stent20010003Total1923739291100
O-006 Pain management of patients with fatigue fractures of the OS sacrum with balloon sacroplasty using different approaches
Authors: Andresen R , Radmer S , Kamusella P , Wissgott C , Banzer J , Schober H 
Published: July 2012

IntroductionIn elderly patients with reduced bone quality, insufficiency fractures of the OS sacrum are relatively common and are typically associated with intense, debilitating pain. The objective of our study was to determine the practicability of cement augmentation using a balloon catheter via individual approaches taking into consideration the complex anatomy of the sacrum and the course of the fracture, as well as the postinterventional determination of leakages and representation of the outcome pain.Material and MethodsIn 30 patients with severe osteoporosis (23 women with an average age of 72.4 years, seven men with an average age of 68.7 years), a sacral fracture was detected by CT and MRT. This fracture was unilateral in 17 women and bilateral in the other patients. In order to achieve a cement distribution longitudinally in relation to the fracture, the balloon catheter was inserted into the OS sacrum via a hollow needle either from caudal to cranial, from dorsal to ventral or from lateral transiliac to medial. The balloon catheter was then inflated and deflated 1–3 times along the fracture in the respective direction, and the hollow space created was then filled with PMMA cement using a low-pressure procedure. A conventional radiograph in two planes and a control CT were then performed. Pain intensity was determined pre-intervention, on the second day post-intervention and 6 and 12 months post-intervention, using a visual analogue scale.ResultsThe balloon sacroplasty was performed successfully from a technical point of view in all patients. The radiographic and CT control showed sufficient cement distribution in the sacrum along the course of the fracture, whereby leakage could be ruled out. According to the visual analogue scale, the mean value for pain was 8.8 pre-intervention, there was a significant reduction in pain on the second postoperative day, with an average value of 2.7 (p<0.001), which was stable at 2.5 after 6 months and 2.3 after 12 months.DiscussionApproaches that take into account the anatomy of the OS sacrum and the course of the sacral fracture enable reliable augmentation with an optimum amount of cement. This makes balloon sacroplasty an effective treatment that has few complications for rapid and significant pain relief in patients with a sacral fracture.Competing interestsNone.
O-007 Carotid stent cell design modified the periprocedural outcomes in the stenting arm of randomized trials of carotid revascularization: a meta-analysis: Abstract O-007 Figure 1
Authors: Almekhlafi M , Yavin D , Mitha A 
Published: July 2012

IntroductionTrials describe a risk of stroke of about 6% following carotid artery stenting (CAS). Stent cell design has been implicated as a potential factor in these risks. The small free cell area between the struts of a closed-cell stent theoretically provides better scaffolding of the vessel wall and superior plaque stabilization compared to the larger uncovered gaps in open-cell stents. No comparison between stent designs, and their relative effects on clinical outcome compared with carotid endarterectomy, has yet been published in the literature.Materials and MethodsThis is an exploratory meta-analysis of randomized control trials (RCTs) comparing carotid endarterectomy (CEA) to CAS stratified by the stent cell design. A comprehensive literature search was conducted on major scholar search engines until July 2010. The primary outcome was a composite of the 30-day risk of stroke or death. A Mantel-Hansel random-effects model was used to calculate OR and 95% CIs.ResultsNine RCTs (4949 patients) were included in the final analysis. Closed-cell stent design was used in 807 patients and open-cell stents in 1657 patients, while 2485 patients were treated with CEA. The primary outcome was significantly lower in the CEA arm compared to CAS using open-cell design arm (OR 1.84, 95% CI 1.23 to 2.75; p=0.003). However, there was no significant difference in the primary outcome between CEA and CAS using closed-cell design, although a trend favoring CEA was noted (OR 1.54; 95% CI 0.69 to 3.47; p=0.29), Abstract O-007 figure 1. If only the 30-day stroke rate was considered, the difference between CEA and CAS in the closed-cell stents is still non-significant (OR 2.92; 95% CI 0.52 to 16.21; p=0.22), compared to open-cell stents which continued to be inferior to CEA (OR 1.97; 95% CI 1.33 to 2.92; p=0.0007).Abstract O-007 Figure 1(A) Periprocedural stroke or death with CEA vsOpen-cell stents. (B) Periprocedural stroke or death with CEA vsClosed-cell stents.ConclusionIn this meta-analysis of nine RCTs, CEA was not superior to CAS in trials using closed-cell stents. While these results may suggest better outcomes of CAS using the closed-cell stents, trials included in this analysis did not randomize patients to open- vs closed-cell stents. Furthermore, trials using the closed design recruited fewer patients than those using open-cell stents. Further assessment of a potential modification of CAS outcomes by stent design is underway with a meta-analysis of prospective CAS cohorts and registries to directly compare open- vs closed-cell stents.Competing interestsNone.
P-001 Outcome of the patients with ruptured basilar artery bifurcation aneurysm who underwent endovascular approach in acute phase—a single center experience
Authors: Lodi Y , Swrankar A , Sethi K , Gaylon D , Bajwa S 
Published: July 2012

BackgroundDue to the presence of a high morbidity and mortality associated with surgical clipping, most of patients with basilar artery bifurcation (BA) aneurysm are offered endovascular therapy. Objective of our study is to report our technical and clinical outcomes of BA ruptured patients who underwent endovascular therapy.MethodsConsecutive patients with the diagnosis of ruptured BA aneurysms who underwent endovascular repair of aneurysm from 2007 to 2011 were enrolled. Patient's demographics including presenting Hunt & Hess (H&H) grade, Fisher scale, and aneurysm's morphology, use of stent, intra-operative complications and radiographic outcome were measured. Additionally, a 90 days clinical outcome was measured using Glasgow Outcome Scale (GOS).Results20 patients with a mean age of 51±13 year underwent successful repair of the ruptured BA bifurcation aneurysms. Most of the patient were women (80%) and 75% of patients were active smoker. H&H I was present in 6 (30%), H&H II in 4 (20%), H&H III in 3 (15%), H&H IV in 6 (30%) and H&H V in 1 (5%) of patients. 10 patients with wide-necked aneurysms required stent-assisted coiling in the acute phase and were given oral loading doses of clopidogrel (300 mg) and aspirin (325 mg) at least 2 h prior to the stent deployment. There was no incidence of intra-operative or postoperative intracranial or systemic hemorrhages or thromboembolic event. Immediate complete (7) and near complete (9) obliteration was observed in 80% and subtotal in 4 (20%) of patients. 30 days good outcome (GOS 5 in 12, GOS 4 in four) was observed in 80% of patients including four of seven patients presented with poor grades (H&H IV & H&H V). Poor outcome (GOS 3) was observed in 4 (20%) of patients. When these patient were examined in 90 days; good outcome (GOS 5 in 14, GOS 4 in four) was observed in 90% including six of the seven patients who had presenting poor grades.ConclusionsEndovascular techniques offer successful repair of ruptured BA aneurysms including those with wide neck and required stent-assisted coiling. Good outcome was observed in most of our patients including those with poor clinical grade. Poor H&H grade was not associated with poor long-time outcome in our series. Further study is required to evaluate the role of Hunt & Hess grade in BA aneurysm in a broader scale.Competing interestsNone.
P-015 Novel use of the pipeline embolization device for reperfusion of the middle cerebral artery post aneurysm clipping: Abstract P-015 Figure 1
Authors: Turner R , Turk A , Chaudry I , Nyberg E 
Published: July 2012

IntroductionSurgical clipping of intracranial aneurysm can be complicated by clip encroachment of the parent artery. We present a case where symptomatic MCA stenosis occurring after clipping of a left carotid terminus aneurysm with reperfusion was restored using a Pipeline Embolization Device to buttress open the MCA.Case reportA 61-year-old African American underwent an orbito-zygomatic craniotomy of multiple aneurysms, including a 15 mm left carotid terminus aneurysm. After clip placement the left carotid terminus, ACA, and MCA origins were widely patent with a 2 mm dog ear remnant along the MCA (top figure) Abstract P-0015 figure 1. The anterior dome of the aneurysm was incised and showed no filling of the aneurysm. There was no vascular kinking or compromise of flow in the carotid terminus or MCA measured by intra-operative Doppler. Post-operatively the patient's neurological exam declined to somnolence, confusion and right-sided hemiparesis. CT/CTA/CTP demonstrated patency of the left carotid terminus and MCA, a small infarct in the left lentiform nuclei, and markedly increased mean transit time in the left MCA territory with preservation of the cerebral blood volume. Diagnostic angiography demonstrated a critical narrowing of the carotid terminus and MCA origin with delayed flow through the left MCA territory (bottom left figure) Abstract P-015 figure 1. There was no filling of the aneurysm, including the dog ear remnant noted at surgery. A 3.0×18 mm PED was advanced across the narrowing and deployed followed by intra-device angioplasty. Post PED and angioplasty angiography demonstrated improved caliber of the narrowed segment with markedly improved perfusion of the MCA territory (bottom right figure). The aneurysm remained completely occluded.Abstract P-015 Figure 1DiscussionArterial stenosis due to an aneurysm clip traditionally required surgical re-positioning of the aneurysm clip. Endovascular options are limited due to poor radial resistive forces of neurovascular nitinol stents. However, cobalt chromium has a higher specific modulus than nitinol that makes it an attractive high stiffness, low weight material. As such, Pipeline should have a steeper loading curve and corresponding radial resistive force, than nitinol stents. In addition, the static friction at the points of intersection of the braided tines may also provide additional resistance to deflection.ConclusionSuccessful restoration of flow using Pipeline was achieved without complication.Competing interestsR Turner: Microvention, Codman. ev3, Penumbra, Mindframe. A Turk: None. I Chaudry: None. E Nyberg: None.
P-016 Snare-Monorail technique during pipeline embolization of a large cavernous carotid aneurysm: a technique to overcome severe tortuosity
Authors: Turner R , Turk A , Chaudry I , Nyberg E 
Published: July 2012

IntroductionFlow diversion is a treatment option for large and giant anterior circulation aneurysms, however tortuosity can preclude the ability to use this therapy.Case presentationA 59-year-old female presents with cavernous sinus syndrome of the right eye and a large cavernous carotid aneurysm. Just distal to the aneurysm were two 180° turns in the carotid artery. Attempts to navigate distal to the aneurysm with traditional 0.014′ microwires resulted in herniation of the microcatheters and wires into the aneurysm. Multiple attempts using various microwires, including a “buddy-wire” system failed to navigate and deliver the microcatheter to the carotid terminus. An 0.010′ microwire was navigated to the carotid terminus however did not offer enough support to navigate a microcatheter. A microvascular snare was navigated up the contralateral carotid and across the anterior communicating artery to the ipsilateral carotid artery. The microwire was ensnared at the carotid terminus, creating a rigid and supportive monorail (Abstract P-0016 figure 1). Over this system, a 0.026” microcatheter was navigated into position and two Pipeline devices were deployed across the neck of the aneurysm, successfully embolizing the aneurysm (Abstract P-0016 figure 2).Abstract P-016 Figure 1Abstract P-016 Figure 2DiscussionTreatment of large and giant aneurysms with flow divesion can be difficult due to tortuosity and the relative stiffness of the devices. By anchoring a microwire distally, a rigid monorail system can be created to deliver the catheters into position. The snare allows for entrapping and releasing the delivery devices as needed to complete the procedure.ConclusionChallenging cases require utilization of devices that are outside normal indications, however within the capabilities of the devices. Knowledge of these technics can allow for treatment of otherwise untreatable vascular diseases.Competing interestsR Turner: Microvention, Codman. ev3, Penumbra, Mindframe. A Turk: None. I Chaudry: None. E Nyberg: None.
P-017 Radiation target delineation of micro brain arteriovenous malformations using high-resolution flat-detector cone-beam Computed Tomography (CBCT): Abstract P-017 Figure 1
Authors: van der Bom I , Wakhloo A , Kuhn A , Ding L , Goff D , Gounis M 
Published: July 2012

PurposeRadiation therapy has shown to be an effective treatment of brain arteriovenous malformations (bAVMs).1 2Target delineation is commonly performed on volumetric image data, such as MRI or CT data. However, the nidi of micro-AVMs may not be visualized adequately by these modalities due to their limited image resolution. In this report, we show a novel usage of high-resolution contrast-enhanced cone-beam computed tomography (CBCT) imaging and multi-modal image registration3for radiation target delineation of a micro-AVM, a technique previously suggested for larger AVMs.4CaseA 42-year-old male presented with intraparenchymal hemorrhage in the mesencephalic tectum and left posterior thalamus. Conventional angiography revealed a left superior collicular AVM with a nidus of 3 mm. The AVM was successfully embolized but follow-up angiography examinations at 36 months demonstrated a small re-growth of the AVM (Abstract P-017 figure 1A). The patient was thus referred to radiosurgery. Thin slice contrast and non-contrast MRI acquired for target delineation did not show the AVM nidus. Therefore, the patient was transferred to the angiography suite for high resolution contrast-enhanced CBCT. Data was acquired using the angiography c-arm system with a reduced detector size of 22 cm. Contrast was injected with 2 ml/s for a total of 64 ml and a 2 sec delay) using a coupled power injector into the left vertebral artery with a 5Fr catheter. Volumetric CBCT data (FOV: 703 mm3, matrix: 0.143 mm3) was generated using a non-binned reconstruction algorithm. Lesion and nidus were visualized with CBCT. MRI, CT-simulator and CBCT data was then transferred to the radiation planning software and mutually co-registered. The nidus was delineated on CBCT data by an experienced neurointerventional radiologist for radiation therapy and dose/treatment plan was completed. Due to image registration, the target area could be directly transferred to MRI and CT data (Abstract P-0017 figure 1B). The patient received a total of 4 radiation sessions.Abstract P-017 Figure 1Discussion and ConclusionRadiation target delineation of micro AVMs can be challenging with conventional 3D imaging techniques as their spatial resolution is relatively low for the application of visualization of the nidus. We were able to demonstrate the complementary value of high resolution contrast enhanced CBCT in radiation target delineation of a micro brain AVM. Multi-modal image registration of CBCT with MRI and CT-simulator has shown to be an effective method for radiation target delineation.Competing interestsI van der Bom: None. A Wakhloo: Philips Healthcare. A Kuhn: None. L Ding: None. D Goff: None. M Gounis: None.References1.AJNR1995;16:299.2.J Neurosurg2002;97:779–84.3.vanderBom IMJ,et al. J NeuroIntervent Surg2011. In press.4.Radvany MG,et al. J NeuroIntervent Surg2011. In press.
P-019 Mid-term results of single or multiple overlapping neuroform stents as monotherapy for treating supraclinoid carotid “blister-like” pseudoaneurysms
Authors: Spiotta A , Walsh K , Bhalla T , Hui F 
Published: July 2012

Introduction“Blister-like” pseudoaneurysms of the supraclinoid internal carotid artery have a malignant natural history and can be difficult to treat, both surgically and via endovascular techniques. These lesions often involve a long arterial segment and lack a defined saccular component that would safely accommodate the introduction of embolization coils. This report describes follow-up data from patients who underwent Neuroform stent reconstruction as monotherapy.MethodsA retrospective review was performed on a prospectively maintained Neuroform stent database at our institution. Patients who had undergone stent reconstruction of supraclinoid ICA “blister-like” aneurysms were included. Long-term clinical and angiographic data was obtained and analyzed.ResultsEight patients were identified (mean age 61.1 years; five female, three male) who underwent stent reconstruction using Neuroform stents; seven (87.5%) were treated in the ruptured setting. Three patients presented in Hunt and Hess (HH) grade 2, two in HH3, and one presented months after rupture, with no documented HH score. All patients underwent endovascular Neuroform stenting of their aneurysms. Initial angiographic results were as follows: complete occlusion (Raymond 1; n=3; 37.5%) and residual aneurysm (Raymond 3; n=5; 62.5%). There were no intraprocedural complications. There were no cases of re-bleeding. Clinical follow-up data (range 1–34 months; average 12.4 m) was obtained from all patients and angiographic follow-up data (range 1–28 months; average 10.9 m) was obtained from seven patients (87.5%). Follow-up angiographic results are as follows: complete occlusion (Raymond 1; n=6; 75%) and residual aneurysm (Raymond 3; n=2; 25%). Clinical outcomes are as follows: mRS of 0 (n=2; 25%), mRS of 1 (n=5; 62.5%) and mRS of 2 (n=1, 12.5%). No patients had mRS of 3 or greater. Two patients (25%) required retreatment, one required ICA sacrifice with STA-MCA bypass, and the other required emergent endovascular intervention with abciximab for stent thrombosis. Neither of these patients suffered permanent neurological deficits.ConclusionEndovascular stent reconstruction of supraclinoid ICA “blister-type” aneurysms using the Neuroform stent is an effective treatment option even in the setting of subarachnoid hemorrhage. Stent reconstruction prevents aneurysmal reruptures and is associated with favorable long-term clinical and angiographic outcomes.Competing interestsA Spiotta: Integra, Hemedex. K Walsh: None. T Bhalla: None. F Hui: None.