bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-039 Coil packing volume in the treatment of ruptured intracranial aneurysms and the rate of recurrence
Authors: Cornett O , El-Gengaihy A , Gandhi C , Prestigiacomo C 
Published: December 2010

IntroductionThe recanalization rate of cerebral aneurysms treated by coil embolization has been reported to be as high as 60%. Several characteristics have been shown to correlate with coil compaction and recanalization including: large aneurysm size, wide neck and basilar tip location. In vitro models of side wall aneurysms show that even with maximal packing such that coil herniation into the parent vessel occurs, there remains unfilled volume within the aneurysm. This raises the question of whether or not there is a minimum threshold packing density that should be achieved to prevent recanalization. Further, is there a difference in packing density when an operator is treating a ruptured versus an unruptured cerebral aneurysm?PurposeTo compare the packing density in ruptured and unruptured cerebral aneurysms and to assess whether this impacts on the recanalization rate.MethodsWe conducted a retrospective chart review of consecutive patients who presented to University Hospital for treatment of cerebral aneurysms between September 2003 and January 2010. We included only patients that underwent coil embolization for spherical aneurysms in our analyses. We identified 43 cerebral aneurysms of which 23 were ruptured at the time of treatment. Aneurysm volume, coil volume and packing density percentage were calculated using the web based Angiocalc program based on measurements obtained during the treatment angiogram. Follow-up angiograms were obtained for all aneurysms between 3 weeks and 1 year. Aneurysm recanalization was graded using the Raymond Score (RS).ResultsWe identified 43 spherical aneurysms, 20 of which were unruptured. 76% of the patients were women and mean patient age in the unruptured and ruptured groups were 52 and 51 years, respectively. Linear regression analysis identified a statistically significant correlation between aneurysm volume and coil volume for both the ruptured and unruptured aneurysms (p=0.001 and p=0.023, respectively). In the unruptured group there was a correlation between aneurysm volumes and RS at follow-up (p=0.0074) with smaller aneurysms having durable occlusion at follow-up. Coil volume correlated with RS at follow-up in the unruptured group (p=0.026). Mean packing volume in unruptured aneurysms was 15.97 mm3versus 45.7 mm3in ruptured aneurysms but there was no difference in RS between the groups at follow-up.ConclusionIn both groups aneurysm volume was strongly related to coil volume but this did not translate to packing volume percentage. We achieved durable RS occlusion at follow-up, especially in the smaller volume aneurysms. There was a trend towards lower RS scores at follow-up with higher packing volume but this did not reach statistical significance in either group.
E-049 Single versus staged stent assisted coiling techniques for intracranial aneurysms: comparison of complication rates, and immediate and long term angiographic outcome in a single institution experience
Authors: Alaraj A , Hage Z , Munson T , Amin-Hanjani S , Charbel F , Aletich V 
Published: December 2010

IntroductionEndovascular management of intracranial aneurysms include stent assisted techniques for wide neck complex aneurysm. Two approaches are being used for stent assisted coiling, single versus staged coiling after stent ‘endothelialization’. Comparative outcomes of these two methods are the purpose of this study.MethodsMedical records and angiographic results were reviewed for 133 aneurysms treated between October 2003 and November 2008 with stent assisted coiling, single stage (62 aneurysms) or staged treatments (71 aneurysms). Demographics, outcomes and angiographic features were reviewed.ResultsPatient demographics between the two cohorts were not statistically different by univariate analysis in terms of age, clinical presentation, aneurysm location, follow-up duration and presence of fusiform aneurysms. Aneurysm characteristics in single versus staged treatment were: average neck diameter (5.2±1.6 mm) versus (6.0±2.9 mm) (p=0.07); dome diameter (7.5±3.4 mm) versus (8.9±0.2 mm) (p=0.42); and dome/neck ratio (1.5±0.4) versus (1.4±0.6) (p=0.39) respectively. Fusiform aneurysms were comparable in the two groups. There was a statistically significant difference in immediate, good angiographic results (95–100% occlusion) (55.6% vs 44.5%; p=0.04) but not in long term angiographic results (46.2% vs 53.8%), the need for treatment (11.3% vs 12.6%) or in the rate of in-stent stenosis (7.6% vs 7.6%) in single versus staged treatment. There was no difference in complication rates with regard to coil protrusion (p=0.3), clot/emboli formation (p=0.3) or rupture/dissection (p=0.5). Two patients had rebleeding from a ruptured aneurysm postpartial treatment with single staged stent assisted coiling 3 days after the treatment.ConclusionsIn a controlled cohort, aneurysms treated with single stage had a similar long term angiographic results with the same complication rates compared with multistage treatment.
E-050 Stent assisted coil embolization for large and giant fusiform dissecting aneurysms: a series of 38 cases
Authors: Choulakian A , Eboli P , Mukherjee D , Alexander M 
Published: December 2010

IntroductionFusiform aneurysms present a challenge for treatment since their dome to neck ratios are often less than 1. These are cases that are excluded from most aneurysm series, and prior to intracranial stents were thought not to be treatable by embolization, except by parent artery occlusion.MethodsThis is a retrospective analysis of a prospectively collected database of 38 patients who had stent assisted coil embolization of a large or giant fusiform aneurysms. A total of 21 patients had two telescoping stents placed and four patients had three telescoping stents. There is an analysis of the procedure related complications, re-treatments, symptomatology and delayed follow-up.ResultsThe average aneurysm size treated was 21.4 mm (range 12–61), with an average neck of 18.6 mm. In the periprocedural period there was a 10% complication rate with two strokes and two increased cranial neuropathies. Nine of the patients required re-treatment during a mean follow-up time of 38 months. There were two deaths in the follow-up period: one due to subarachnoid hemorrhage, another presumed due to respiratory arrest.ConclusionsAlthough stand alone flow diversion devices are being developed and evaluated, stent assisted coil embolization is an effective alternative to fusiform and fusiform dissecting aneurysms. The periprocedural complication rates are reasonable (10%), and although re-treatment is frequently necessary, the long term outcomes are better than the natural history of this disease.
E-051 Upper cervical spinal dural arteriovenous fistulae: an under recognized entity?
Authors: Gandhi D , Huang J , Choudhary A , Kathuria S 
Published: December 2010

IntroductionSpinal dural arteriovenous fistulae (dAVFs) are uncommon lesions that often present with slowly progressive myelopathy. These shunts are located most commonly in the thoracolumbar region. A location in the cervical spine is considered exceedingly rare and has been reported most often in the context of subarachnoid hemorrhage. We report a series of five cases of upper cervical dAVFs and describe the clinical and angiographic characteristics of these lesions.Materials and methodsA review of interventional neuroradiology database identified five patients with upper cervical dural arteriovenous fistulae (CdAVFs). We performed a review of the patient charts, imaging studies, including digital subtraction angiography (DSA) and C arm CTs (when available), and the operative records. The imaging studies were reviewed by two neuroradiologists with experience in spinal angiography and interventions. We also performed a detailed review of the English literature on this entity.ResultsMean age of the patients was 61.6 years (range 45–75 years). There were three men and two women. Four of the five patients presented with subarachnoid hemorrhage (SAH) that could be attributed to the CdAVF. One patient had an incidental detection of the CdAVF while undergoing cerebral angiography for a ruptured left posterior communicating aneurysm. The fistulae were located at C1 or C2 level and supplied by C1/C2 radicular arteries. Small branches of anterior or lateral spinal artery were noted to supply the fistulae in four of the five patients. Embolization was performed in 3/5 lesions and was curative in one. Reduction in flow was accomplished in 2/5 but definitive cure using endovascular therapy was not possible due to small size of the feeder vessels and/or supply from ASA. One of these two patients has had microsurgical obliteration of the fistula. Two patients are being medically observed, one with incidentally detected fistula and another who refused microsurgical therapy.ConclusionUpper cervical dAVFs may possibly be an under recognized entity. Approximately half of the reported cases have presented with SAH. Endovascular therapy is often difficult due to small size, eloquent nature and multiplicity of feeder vessels. Microsurgical therapy is also difficult but may offer a chance of complete obliteration in selected cases. In high risk cases, expectant management may be reasonable since the clinical course from the hemorrhage seems to be fairly benign and significant complications from SAH are uncommon. We advocate bilateral selective vertebral angiography (in addition to usual DSA workup) with the inclusion of their cervical segments in evaluation of any patient with hemorrhage in the region of the foramen magnum/upper cervical spine. These lesions have a higher chance of detection if the upper cervical spine is included in the imaging field of view.
E-055 Mechanical thrombectomy with the Penumbra System for treatment of venous sinus thrombosis
Authors: Choulakian A , Alexander M 
Published: December 2010

ObjectiveVenous sinus thrombosis can be a fatal condition. When systemic anticoagulation therapy fails or is high risk, endovascular chemical thrombolysis or mechanical thrombectomy may be necessary. We report our experience using the Penumbra System (PS; Penumbra, Alameda, California, USA) in a series of four patients with venous sinus thrombosis.MethodsFour patients were treated with mechanical thrombectomy using the PS for venous sinus thrombosis. Three of these patients also underwent balloon angioplasty following the PS device. Utility of this technique was evaluated by procedural success, improvement in neurological condition, avoidance of complications and follow-up imaging.ResultsTechnical success was achieved in all four patients with restoration of flow in the occluded sinuses without the use of chemical thrombolysis (Abstract E-055 table 1). No complications were encountered during the procedure and no postprocedural complications were attributable to the thrombectomy. One patient with glioblastoma died 6 weeks after the procedure. No new intracerebral hemorrhages (ICH) were caused and there was no exacerbation of pretreatment ICHs. Follow-up imaging was available in all but one patient to documented continued sinus patency. Neurologic improvement was seen in all patients after thrombectomy. Two patients have returned for outpatient follow-up and both are doing well.Abstract E-055 Table 1Results for the four patientsPatient NoPresenting symptomsRisk factorsAnticoagulationICHThrombosed sinusesTime to treatmentProcedureFollow-up imagingNeurologic status1Decreased LOCHITLepirudin post-procedurePreprocedureSSS<1 dayPenumbra, balloon angioplastyStable CTVImproved mental status2Headache, nausea, vomitingMastoiditisHeparin pre and postprocedureNoneR TS R SS R IJ4 daysPenumbra, balloon angioplastyStable MRVMild headache at 3 months3Iatrogenic SSS injuryHypercoagulableNoneNoneSSS R TS<1 dayPenumbraStable angiogramDead at 6 weeks (GBM)4Quadriplegia, aphasia, lethargyBirth control pillsHeparin postprocedurePreprocedureSSS8 daysPenumbra, balloon angioplastyNoneNormal at 3 monthsConclusionEndovascular treatment for venous sinus thrombosis with the PS is a safe and efficacious alternative to the other forms of mechanical thrombectomy reported in the literature. Good clinical and radiographic results can be obtained without the need for chemical thrombolysis.Abstract E-055 Figure 1Abstract E-055 Figure 2
E-058 Basilar artery recanalization status after endovascular therapy does not predict outcome
Authors: Raghuram K , Rai A 
Published: December 2010

PurposeBasilar artery occlusion is a devastating event without treatment. With the advent of mechanical and endovascular therapy, one would expect an improvement in outcomes.Materials and methodsWe retrospectively reviewed patient records on 17 patients who presented with acute basilar artery thromboembolism and underwent an interventional procedure. The admission clinical findings, CT and CT angiogram, angiographic images and follow-up CT/MRI were reviewed. Clinical follow-up was also recorded. Statistical methods to analyze the findings were performed using JMP software.Results12% of patients had a good outcome and 18% were lost to follow-up. NIH stroke scale at admission had a direct correlation with outcome (modified Rankin scale). Recanalization did not directly correlate with outcome. Postprocedure hemorrhage was higher with larger doses of tissue plasminogen activator (tPA) and adding a mechanical device (MERCI) did not significantly improve outcome compared with tPA. Older age, higher admission National Institutes of Health Stroke Scale (NIHSS) were indicators of an adverse outcome. Complete basilar occlusion was associated with a worse outcome than a partial occlusion but the difference did not approach statistical significance.ConclusionsIn this single center experience analysis, we were unable to identify any statistically significant angiographic predictors of outcome. Specifically, recanalization of the basilar artery did not correlate with good outcome. NIHSS at admission was an independent predictor of outcome. Basilar occlusion remains a complex and debilitating condition that is not satisfactorily treated by any current methods, including interventional techniques.
E-006 Urgent recanalization using stents for acute internal carotid artery occlusion in progressive stroke patients
Authors: Lee T , Sung S , Lee S 
Published: December 2010

BackgroundRe-establishing cerebral blood flow in a timely fashion during an acute stroke has been shown to be efficacious in improving patient outcomes. Complete occlusion of the internal carotid artery (ICA) in progressive stroke patients would be expected to bring about devastating neurological sequelae and probably not be compatible with survival unless it could be treated. We retrospectively analyzed the feasibility, safety and effectiveness of the urgent recanalization using stents for acute ICA occlusion in the progressive stroke syndromes.MethodsBetween January 2008 and December 2009, urgent recanalization using stents for acute ICA occlusion was performed in 21 progressive stroke patients. The group of patients comprised 16 men and five women, aged 52–83 years (mean age 68.8 years). The occlusion segments of ICA were extracranial in nine patients and intracranial in 12 patients. A 0.014 inch microwire was placed into the distal ICA or middle cerebral artery, crossing the occluded segment. The stent was then advanced over the microwire and deployed in the lesion.ResultsWe achieved successfully complete recanalization using stents in 19 of 21 patients (90.1%). We could not advance the stent delivery system into the lesion in two patients because of the vascular tortuousness. During the procedure, ICA dissection occurred in two patients (9.5%) and was treated with additional stent placement. There was no symptomatic thromboembolic complication. Fifteen of 19 patients (78.9%) showed the stable or improved neurologic signs and favorable clinical outcomes. Four patients (21.1%) showed brain edema and aggravating neurologic signs and two of them (10.5%) expired due to massive brain edema and herniation.ConclusionUrgent recanalization using stents for acute ICA occlusion may salvage the vessel and promise better clinical outcome in the progressive stroke patients. Endovascular recanalization for ICA occlusion is feasible with acceptable early clinical result.
E-063 Cardiothoracic surgery does not pose significant risk of aneurysmal subarachnoid hemorrhage
Authors: Moskowitz S , Ching E Cheng , Teng Q , Hui F 
Published: December 2010

ObjectiveNeurologic imaging prior to cardiac surgery often identifies incidental intracranial vascular pathology. The risk of hemorrhage from these lesions during an open cardiothoracic surgical procedure is unknown, preventing appropriate patient and surgeon counseling. We sought to identify the risk of aneurismal subarachnoid hemorrhage (SAH) in this population.BackgroundPatients undergoing cardiothoracic surgery often sustain significant hemodynamic fluctuations during and after their procedure. Since the incidence of cerebral aneurysms is estimated as 1–8% based on non-invasive imaging and autopsy studies, the number of patients harboring aneurysms is significant. It is unknown whether the cardiothoracic procedure impacts on the risk of aneurysm rupture.MethodsA prospective database of all cardiothoracic procedures is maintained for a large tertiary care center. Demographic, clinical, procedural and complication data are routinely collected. Data from this were reviewed for all procedures between 2001 and 2009 and neurologic complications identified. All identified strokes were reviewed for ischemia or hemorrhage, and the imaging reviewed for all hemorrhages to describe the pattern with focus on SAH and potential for aneurysms as contributory.ResultsIn this time period, over 10 000 procedures were performed. Neurologic events occurred in 617, of which 71 were hemorrhages. Hemorrhagic transformation of an ischemic stroke accounted for 49 (HI-1, 27; HI-2, 10; PH-1, 8; PH-2, 4). Two subdural hematomas were identified and nine intraparenchymal hemorrhages were seen. SAH occurred in 11, consisting of three as a direct result of a complication from intra-arterial thrombectomy. Seven were small convexity bleeds for which three had vascular imaging performed (all negative). One SAH was the result of a fusiform supraclinoid mycotic aneurysm which developed as a result of bacterial endocarditis. This aneurysm was not present on preoperative vascular imaging and required vessel sacrifice as it continued to grow rapidly and ruptured. No cases of SAH associated with a saccular aneurysm were identified.The incidence of cerebral aneurysms of 1–9% suggests that in this population, 100–900 aneurysms should exist. With no SAH cases identified, the periprocedural risk from aneurysm rupture is less than 0.01–0.001%.ConclusionsAneurysm SAH as a direct result of open cardiothoracic surgery represents a very small risk. Consideration for management should be driven by cardiac indications with insignificant additional risk added by the incidental cerebral aneurysm found preoperatively.
E-064 Endovascular treatment of intracranial aneurysm with stents: experience of a Latin American Country
Authors: Pabon B , Vargas S , Urena P 
Published: December 2010

ObjectiveTo report our experiences in the treatment of wide necked, giant and complex intracranial aneurysms (IAs) with stents.Materials and methodsFrom June 2002 to January 2010, a total of 205 patients with 214 aneurysms were treated in our institutions with stent technique. Data regarding technical success, initial and final angiographic results, mortality, morbidity and final clinical outcome were collected and analyzed retrospectively.Results205 patients with 214 IAs were treated. 47% of the cases had a history of hemorrhage. Regarding the procedure strategy, in 71% of the cases we used stent assisted coiling. Clinical and radiological mid and long term follow-up was obtained in 75% and 56%, respectively. Morbidity was 5.5% and mortality procedure related was 3% (six patients).ConclusionEndovascular reconstruction with stent only or stent assisted coiling represents a safe, durable and curative treatment alternative for selected wide necked, large and giant intracranial aneurysms.
E-065 Revascularization of internal carotid artery occlusion by using a flow reversal system
Authors: Buciuc R , Luzardo G , Khan M , Schlackman B , Uschman H , Wineman R 
Published: December 2010

Introduction and purposeTo assess the feasibility and safety of carotid revascularization in subacute conditions, using a flow reversal system.Materials and methodA total of five patients presenting with subacute carotid occlusion and non-disabling neurologic deficits underwent endovascular revascularization of their occluded vessel by using a flow reversal system as a protection device against embolic phenomena. In two cases, in addition to the flow reversal system a protective filter has been added on prior to completion of revascularization. All patients underwent the intervention under general anesthesia. After revascularization, all patients underwent placement of stents at the locations presumed responsible for their occlusions. All patients were managed immediately in the neurointensive care unit under strict blood pressure control.ResultsTechnically, all of the procedures were successful with no embolic phenomena. In patients where a filter device was used in addition to the flow reversal system, the filter was inspected visually after removal and no clots or debris were identified.There were no neurological deficits associated with the procedure. There were no systemic or local complications associated.In one patient a 6 month clinic and angiographic follow-up was obtained. This demonstrated patency of the stent. The patient did not develop any additional neurological deficits.ConclusionPreliminary results of using a flow reversal system in carotid artery subacute revascularization suggest that this technique is feasible and effective. A larger patient cohort would be necessary to further address the safety of the procedure, indications and long term results.