bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-029 Balloon-augmented target vessel sacrifice with liquid embolic agents
Authors: Bhalla T , Spiotta A , Hui F 
Published: July 2012

IntroductionVessel sacrifice remains a valuable tool in the treatment of select vascular lesions. Conventionally, neurointerventionalists have relied on coil embolization as their primary means of vessel sacrifice since detachable balloons are no longer available. However, coil embolization can be expensive with long fluoroscopy times. We describe a novel technique for vessel sacrifice using temporary balloon occlusion to achieve proximal flow arrest in the parent vessel while embolizing the target vessel with a liquid embolic agent.MethodsA total of three vessel sacrifices (two vertebral, one carotid) were performed in three patients. Balloons were employed to achieve proximal flow arrest to allow an Onyx (Covidien) cast to accumulate in the target vessel following the deposition of coils.ResultsComplete occlusion of the target vessel was achieved in all cases with no complications. Two balloons were employed, the Ascent (Covidien) and Scepter C (MicroVention). Between two and four coils and 0.3 to 0.7 cc of Onyx were employed resulting in significant cost, procedure and fluoroscopy time savings.ConclusionVessel sacrifice using commercially available non-adhesive liquid embolic agents is feasible with balloon assistance, allowing for reduced radiation and material costs. Coils may be beneficial in providing an anchor point for liquid embolic deposition, as well as reducing the volume of liquid embolysate required to achieve vessel occlusion.Competing interestsT Bhalla: None. A Spiotta: 1; C; Integra, Hemedex. F Hui: None.
E-032 Imaging characteristics of tumors of the head and neck: Abstract E-032 Figure 1
Authors: Hardman J , Kato C , Rezai P , Kumar G 
Published: July 2012

PurposeTumors of the head and neck have characteristic findings on MRI and cerebral angiography which help with proper diagnosis and localization. This presentation will provide a review of the characteristic findings of tumors commonly found in the head and neck.Materials and MethodsA retrospective analysis was made of head and neck tumor cases for the past 10 years from the PACS system at Cook County Hospital. All selected cases are biopsy proven.ResultsWe compare and contrast the characteristic MRI and cerebral angiogram findings of glomus jugulare tumors, glomus vagale tumors, carotid body tumors, meningiomas, schwannomas, paragangliomas, central neurocytoma, orbital tumors and metastatic tumors. All of these tumors have typical locations and vascular patterns observed on MRI and cerebral angiography.ConclusionIt is important to carefully analyze the imaging characteristics of tumors of the head and neck as this information will differentiate common tumors from the more complex ones. Each of these tumors have specific findings that use of MR and cerebral angiography, along with patient history, can help to determine further management. This review aims to refresh to the knowledge base of the neurointervenionalist in differentiating between these tumors.Competing interestsNone.Abstract E-032 Figure 1
E-035 Ghost image extraction technique utilizing intraoperative angiography for the controlled removal of an intracranial nail: Abstract E-035 Figure 1
Authors: Braca J , Whapham J , Prabhu V 
Published: July 2012

Penetrating intracranial trauma via nail gun injury is becoming more common and differs significantly from the sequelae of penetrating cranial trauma of gunshot wounds. Safe, effective extraction techniques are therefore necessary and can employ intraoperative angiography (IA). An (IA) Ghost Image Extraction technique for safe removal of an intracranial nail is described here and can be applied to future such situations. A 32-year-old right-handed male with a history of multiple, non-operative closed-head injuries presented complaining of a 3 day history of right retro-orbital headache, blurry vision in his right eye, and C8 distribution parasthesias on the left forearm. CT revealed a 6 cm nail lodged in the right posterior frontal lobe, with the distal tip pointing superior and medially, without evidence of intracranial hemorrhage along the tract. On more pointed questioning, the patient admitted to non-accidental trauma. On arrival to our facility, the patient was afebrile and without meningeal signs. He was neurologically intact with the exception of a subtle left pronator drift and decreased sensation to light-touch distally in the left C8 distribution. The patient went to the angiography suite for pre-operative vascular mapping prior to surgical extraction of the embedded nail. Four vessel cerebral angiography demonstrated the course of the major, distal branches and tributaries of the intracranial vessels and, miraculously, none were injured. Given the proximity of the nail to major intracranial vessels and elegant cortex, the consideration for safe, controlled extraction of the nail involved the use of IA. The five French sheath was left in place. In the operating room after curvilinear incision and appropriate exposure a double concentric craniotomy was performed around the head of the nail. At this point, with the assistance of intra-operative fluoroscopy and angiography, the nail was slowly and carefully removed under direct visualization so as to remove it in the identical course of its entry to avoid further intracranial injury. The subtracted ghost image of the nail (Abstract E-035 figure 1) that appears with IA allows for control of the distal tip of the nail by extraction via the nail's entry path so as to avoid inadvertent laceration of a vessel or further injury to elegant cortex. Periodic angiographic images were obtained during the deliberate extraction to ensure no intracranial vessel injury had occurred. Post-operative CT revealed a small hemorrhage in along the tract of the nail. The patient did well postoperatively.Abstract E-035 Figure 1Competing interestsNone.
E-038 Acute histologic changes observed in swine arteries treated with a mechanical thrombectomy device: Abstract E-038 Figure 1
Authors: Yuki I , Kan I , Golshan A , Vinters H , Kim R , Yin N , Duckwiler G , Vinuela F , Murayama Y , Vinuela F 
Published: July 2012

Background and purposeEffectiveness of currently used mechanical thrombectomy devices has been evaluated using animal models mainly based upon the angiographical data analysis. However very little has been described about the histologic changes observed in the arteries treated with mechanical thrombectomy devices. The purpose of this study is to evaluate acute arterial histologic changes induced by mechanical thrombectomy using a dedicated swine stroke model.Materials and MethodsA total of eight Superficial Cervical Arteries in four swine were occluded with experimental thrombus and treated using the Merci Clot Retrieval System®. Each treated artery was harvested immediately after the procedure and histologic analysis of each arterial sample was performed. Four untreated Superficial Cervical Arteries were used as controls.ResultsA total of 24 attempts at clot retrieval were made. The average number of retrieval attempts per artery was three. Circumferential intimal denudation and separation of smooth muscle layers in the tunica media were seen in all samples. The intimal denudation was seen regardless of the number of retrieval attempts. A minor sub-intimal dissection was seen in one artery. Arterial perforation with sub-adventitial hematoma was seen in two arteries and these findings were associated with microwire/microcatheter navigation rather than the use of the clot retrieval device.ConclusionMinor histologic changes including intimal denudation and separation of smooth muscle layers in tunica media were seen in every artery treated by mechanical thrombectomy. Two arteries that showed major histologic change (sub-adventitial hematoma) were both associated with microwire/catheter navigation rather than the use of the clot retrieval device. It is possible that major arterial injury (eg vessel perforation) during the mechanical thrombectomy is more likely to be associated with microcatheter/microwire navigation rather than clot retrieval itself. This animal model may be useful in the preclinical safety evaluation of the mechanical thrombectomy devices.Competing interestsI Yuki: None. I Kan: None. A Golshan: None. H Vinters: None. R Kim: None. N Yin: None. G Duckwiler: Concentric Medical. F Vinuela: None. Y Murayama: None. F Vinuela: None.Abstract E-038 Figure 1
E-004 Comparison of lesion and PH volumes: interventional management of stroke (IMS) I, II vs Solitaire Study: Abstract E-004 Table 1
Authors: Javadi A , Tomsick T , Carrozzella J 
Published: July 2012

Introduction/purposeMinimizing the ischemic damage to the brain after intracranial arterial occlusion is critical in improving the patient's prognosis. Solitaire FR Revascularization Device offers a potential new solution for quick recanalization of the occluded vessels, potentially reducing infarct volume and improving outcome. The purpose of this project is to assess and compare the effect of the Solitaire Device on patients' infarct and hemorrhage volume, as compared to combined IV/IA rtPA therapy in IMS I/II.MethodsThe 24-h CT (n=99) and MR images (n=10) from subjects in the retrospective Solitaire Study with ICA-T, M1, or M2 occlusions were made available for analysis. The volume of lesions (infarct + hemorrhage) was measured using volume measurement software. Volumes were compared to similar occlusions treated in the IMS I/II studies (n=89), previously measured in similar fashion. Any parenchymal hematoma (PH) was also separately measured and classified as PH1 or PH2. PH volumes were also compared between Solitaire Study and IMS I/II studies.ResultsIn the Solitaire study, there were 9 PH1 (8.3%) and 6 PH2 (5.5%). In IMS, there were 12 (13.4%) PH1, and 6 (6.7%) PH2. Results of volume measurements, including subjects with no PH, are summarized in Abstract E-004 table 1.Abstract E-004 Table 1PH and lesion mean volumes, IMS I & II compared to Solitaire StudyIMS, I/II (n=89)Solitaire (n=109)p ValueMean lesion volume (all cases)80.661.60.056Parenchymal hematoma 1 (PH1) PH 1 volume ml14.69.50.17 Lesion (PH 1 + infarct) volume ml155.2132.2NSParenchymal hematoma 2 (PH2) PH 2 volume ml22.81010.004 Lesion (PH 2 + infarct) volume ml60.8167.50.03Non-PH lesion volume ml78.148.30.02ConclusionSignificant differences in lesion volumes between the Solitaire Study and IMS I/II may indicate a clinical benefit in using Solitaire FR Revascularization Device for recanalization of occluded arteries. Other potential clinical and imaging contributors to volume differences will be analyzed and discussed. Whereas the findings reported are hypothesis generating, more conclusive prospective research is needed for confirming the findings of this preliminary analysis. Similar analysis in the recently-completed prospective, randomized SWIFT Study is planned.Competing interestsA. Javadi: ev3/Covidian. T. Tomsick: ev3, Covidian. J. Carrozzella: ev3/Covidian.
E-040 Evaluation of peri-procedural blood loss in acute ischemic stroke patients undergoing endovascular revascularization
Authors: Noorian A , Rangaraju S , Owada K , Glenn B , Belagaje S , Anderson A , Frankel M , Gupta R , Nogueira R 
Published: July 2012

BackgroundTo date, there have not been any studies to evaluate the extent of blood loss and its significance in the hospital course of acute ischemic stroke (AIS) patients undergoing endovascular revascularization.ObjectiveThe aim of this study was to evaluate the extent of peri-procedural blood loss measured by hemoglobin (Hb) and hematocrit (HCT), in AIS patients undergoing endovascular revascularization.Design/methodsConsecutive AIS patients in Grady Memorial Hospital were retrospectively analyzed. The AIS transfers from outside hospitals were excluded from this study given lack of available data about pre-procedure Hb/HCT levels. The HCT and Hb right before (PRE-HCT and PRE-Hb) and within 24 h after the endovascular procedure (POST-HCT and POST Hb) were recorded. Patients' demographic information, baseline NIHSS, site of occlusion, revascularization modalities, and the need for transfusion early after the procedure were documented. Descriptive statistics are provided.ResultsForty-one patients (age 68±14; 46% male) with large vessel occlusions were included (26 patients with M1 occlusion, nine patients with M2/3 occlusion, seven patients with ICA occlusion and two patients with basilar/PCA occlusions). The mean NIHSS was 18. Patients had PRE and POST HCT/Hb of 39.3±5.3/ 13.1±1.8 and 34.5±5.3/ 11.5±1.8, respectively. The extent of drop from PRE to POST HCT/Hb (4.7±3.6/1.5±1.2) was statistically significant (paired t-test, p<0.0001). Six patients (14.6%) had HCT/Hb drop >9.0/3.0. The type of device (Merci vs Penumbra) and use of IV or IA-tPA was not associated with any differences in HCT/Hb drop. Only one patient (PRE HCT/Hb:34.9/11.9; POST HCT/Hb:24.6/8.3) required blood transfusion.ConclusionsOur results suggest some extent of blood loss in endovascular management of acute stroke. However, clinically significant blood loss and blood transfusion requirement are uncommon. Future studies with higher number of patients are needed to further delineate this potential complication.Competing interestsA Noorian: None. S Rangaraju: None. K Owada: None. B Glenn: None. S Belagaje: None. A Anderson: None. M Frankel: None. R Gupta: Concentric Medical, Codman Neurovascular, CoAxia, and Rapid Medical. R Nogueira: Concentric Medical, ev3 Neurovascular, CoAxia, and Rapid Me.
E-042 Immediate procedural outcomes in 35 consecutive pipeline embolization cases: a single-center, single-user experience
Authors: Colby G , Lin L , Gomez J , Paul A , Huang J , Tamargo R , Coon A 
Published: July 2012

Background and ObjectiveFlow diverters are an exciting new class of endovascular devices that treat aneurysms by curative reconstruction of the parent artery. The Pipeline embolization device (PED; Covidien Vascular Therapies, Mansfield, Massachusets, USA) is the first FDA-approved intracranial flow diverting device available in the USA. We present our periprocedural results in a series of 35 consecutive PED cases.MethodsAll patients who underwent PED treatment of an intracranial aneurysm at our institution following FDA approval of the device in April 2011 were included in the series. Patient demographics, aneurysm characteristics, procedural details, and technical and clinical outcomes were analyzed.ResultsThirty-four patients (range 23–78 years, mean age 56.4 years) with 41 unruptured aneurysms (37 anterior circulation, 4 posterior circulation, mean size 11.4 mm, 20/21 large or giant) were treated with the PED. Thirty-four of 35 cases (97%) were successfully completed. A total of 64 PEDs were implanted, with the mean number of PEDs implanted per anterior and posterior circulation cases of 1.2 PEDs and 6.5 PEDs, respectively. A single PED was implanted in 73% of cases. Immediate flow disruption occurred in 97% of the cases. The overal rate of major stroke or mortality was 3% (1 of 35 patients). Minor stroke, cranial nerve palsy, transient neurological deficit, and groin complication occurred in one patient each (3% each, 12% total).ConclusionTreatment of cerebral aneurysms with the PED carries an acceptable risk profile when a rigorous and uniform technique is used. Although the long-term results will need to be analyzed, the immediate procedural outcomes in our series using this technique appear quite promising.Competing interestsG Colby: None. L Lin: None. J Gomez: None. A Paul: None. J Huang: None. R Tamargo: None. A Coon: Covidien.
E-046 Migration of enterprise self-expanding intracranial stent after successful deployment
Authors: Swarnkar A , Ezhapilli S , Lodi Y , Deshaies E 
Published: July 2012

IntroductionEnterprise stent is used for stent-assisted coiling of wide-neck intracranial aneurysms. It is a self-expanding flexible stent and has a close cell design. There are reports of migration of the stent after initial successful deployment.1The purpose of this study is to describe the incidence and extent of migration of the Enterprise stent and its influence on coiling.Materials and MethodsThis retrospective study included 73 patients, (17 male and 56 females), with wide-necked intracranial aneurysms, who underwent stent assisted coiling using Enterprise stent over a period of 4 years. The results of the initial and follow-up cerebral angiograms were evaluated.ResultsThirty four patients (47%) had no displacement of the stent. Thirty five patients (48%) had <1.5 mm displacement of the stent, which was considered not significant. Only four patients (5%) had more than 2 mm migration of the stent after deployment. One of these patients in whom the stent was deployed across a basilar apex aneurysm, had a proximal displacement of the stent of 8.4 mm, with the distal end projecting into the base of the aneurysm. Successful coiling was achieved using waffle-cone technique in this patient. Two patients needed a second stent to allow adequate coverage of the neck of the aneurysm. There were no clinical complications.ConclusionA majority of patients with wide-neck intracranial aneurysms treated with Enterprise self-expanding intracranial stent have no significant migration. A minority of patients develop migration requiring additional stents or modification in technique for coiling.Competing interestsNone.Reference1.Kelly ME, Turner RD, Moskowitz SI,et al.Delayed migration of a self-expanding intracranial microstent.AJNR Am J Neuroradiol2008;29:1959–60.
E-049 Percutaneous embolization of clival dural AVF via foramen ovale
Authors: Urdaneta A , Chen J , Chao K , Feng L 
Published: July 2012

PurposeTo evaluate the feasibility of percutaneous embolization of clival dural AVF with difficult venous access.Materials and MethodsA 69-year-old woman with EF of 15%–20% presented with a 9-month history of progressive right proptosis, chemosis, ophthalmoplegia and visual loss. Angiogram showed a small left clival dural AVF supplied by dural branches of bilateral meningohypophyseal trunks. The recipient vein was in the left dorsal clivus, superior and medial to the Meckel's cave. It drained underneath the posterior clinoid to its counterpart vein on the right side, connecting to a cortical vein and the right superior ophthalmic vein. The right cavernous sinus, right facial vein and bilateral inferior petrosal sinuses were occluded. There was no connection of the fistula to the left cavernous sinus. Transarterial embolization of bilateral meningohypophyseal trunks with Onyx resulted in only partial alleviation of her symptoms. Transvenous embolization was attempted but access to the left clival vein could not be established. Percutaneous embolization was thus planned using CT angiography. A 20 Gauge spinal needle was advanced into the left clival vein via the left foramen ovale under fluoroscopy guidance. The fistula was embolized with Onyx.ResultsAngiographic cure of the dural AVF was immediately achieved. The patient's symptoms improved next day and completely resolved within 2 months. Follow-up angiogram showed durable occlusion of the fistula at 3 months.ConclusionDural AVF in the posterior cavernous sinus and dorsal clivus may be embolized percutaneously via foreman ovale.Competing interestsNone.Abstract E-049 Figure 1Abstract E-049 Figure 2
E-055 Predictive value of flat panel CT for hemorrhagic transformations in acute stroke patients treated with thrombectomy
Authors: Pistocchi S 
Published: July 2012

Background and PurposeHemorrhagic transformations are pejorative for patients with acute ischemic stroke (AIS). We evaluated flat panel CT (FPCT) to detect enhancing brain parenchymal lesions immediately after mechanical thrombectomy (MT) in AIS patients and its ability to predict hemorrhagic transformation within 24 h. The second objective was to evaluate an easy-reading protocol for post-procedure FPCT evaluation by clinicians to enable them to determine the potential risk of hemorrhagic transformation.Material and MethodsTwo neuroradiologists retrospectively and independently reviewed FPCT and 24-h follow-up imagery for AIS patients revascularized by MT. We evaluated brain parenchymal enhancement on FPCT and evaluated its power to predict the occurrence of hemorrhagic transformation within 24 h detected with conventional cross sectional imaging (CT, MR) on 63 consecutive patients. κ test was used for inter observer agreement.ResultsWe observed a large homogeneity between the different readers (two neuradiologists and one intensivist). Thirty-eight patients were followed at 24 h with conventional non-enhanced CT, 25 patients with MRI. 60.3% of the 63 included patients presented a post procedural parenchymal enhancement and 53.9% had hemorrhagic transformation. 84.2% of patients with enhancement presented hemorrhagic transformation, vs 8.0% of the patients without enhancement (p<0.0001). No significant hemorrhagic transformations were detected on the 24-h follow-up for patients without enhancement. Sensibility and specificity of enhancing parenchymal lesions on FPCT for the prediction of hemorrhagic transformation were respectively 94.1% (80.3–99.3) and 79.3% (60.3–92.0). The positive and negative predictive values for the occurrence of a hemorrhagic transformation were 84.2% (68.8–94.0) and 92% (74.0–99.0). For significant PH2 hemorrhagic transformation, sensibility and negative predictive value of FPCT were 100%.ConclusionsIn the light of our results, FPCT can be deemed as effective as conventional CT scans to predict the risk of 24 h hemorrhagic transformation. FPCT is cost effective and augments patient safety in the setting of MT of AIS patients.Competing interestsNone.
E-057 Embolization of a spinal dural AV fistula after super selective WADA test spinal AV fistula presenting as foot drop: Abstract E-057 Figure 1
Authors: Nduku V , Barrer S , Shah Q , Kozak O , Yoon M , Meagher R , Gopez J 
Published: July 2012

Spinal arteriovenous malformations are uncommon lesions that present with a constellation of nonspecific symptoms eluding most clinicians. They comprise 3%–16% of all compressive spinal cord lesions and are attributed to 30% of idiopathic myelopathies. They are most often diagnosed on imaging by a neuroradiologist. They can present with symptoms of myelopathy and radiculopathy mimicking a plethora of pathologies. We report the case of a 79-year-old female who presented with back pain and a left foot drop. MRI suggested edema in the conus medullaris and a spinal angiogram revealed serpiginous enhancement from T11-L1 consistent with a type I AVM (Dural AV fistula). She eventually underwent successful embolization after a super selective WADA test with complete occlusion of the Spinal AV fistula.Competing interestsNone.Abstract E-057 Figure 1