bluuebunny/crossref_metadata_2025_split huggingface dataset:
O-015 Cost-effectiveness of vertebroplasty and kyphoplasty vs non-surgical management for symptomatic vertebral compression fractures in the USA
Authors: Win S , Do H 
Published: July 2011

Introduction and PurposeVertebroplasty (VP) and Kyphoplasty (KP) are minimally invasive surgical procedures which can relieve the pain of osteoporotic vertebral compression fractures (VCFs) and increase the functionality of patients, as supported by a number of recent randomized controlled trials. VCFs can present with debilitating back pain, uncontrolled by pain medications, that can seriously impede activities of daily living and lead to additional morbidity and mortality. The purpose of this study is to perform a cost-effectiveness analysis comparing VP, KP, and non-surgical management (NSM or conservative medical therapy) for US patients with painful VCFs.Materials and MethodsA Markov transition state model was created with three treatment strategies: VP, KP, and NSM. A hypothetical cohort of 70-year-old men and women was followed for 30 years or until death. Inputs for the model originated from the published medical literature. Health outcomes were measured in quality-adjusted life years. The economic outcome measure of the model was the difference in healthcare costs among the three treatment strategies. Deterministic 1-way and probabilistic sensitivity analyses were performed to test the robustness of the model.ResultsVP and KP both dominated NSM. When VP and KP were compared, VP was preferred with an incremental cost savings of US$75 000 per quality-adjusted life years gained. Overall, VP was the preferred treatment strategy for symptomatic VCFs. 1-way sensitivity analyses comparing NSM to VP and NSM to KP showed that the cost of physical therapy after NSM was the variable most sensitive to the incremental cost-effectiveness ratio. At willingness to pay of US$50 000, VP was the preferred strategy with probability of 100%. This preference extended to willingness to pay US$25K and US$100K, respectively.ConclusionThe balance of costs and effectiveness favors Vertebroplasty. This favors, from a societal perspective, VP as the preferred treatment strategy for painful osteoporotic VCFs.
O-023 Pre-clinical model of porcine arterial tortuosity for in vivo testing of neuroendovascular devices
Authors: Carniato S , Mehra M , King R , Wakhloo A , Gounis M 
Published: July 2011

IntroductionPreclinical testing of endovascular devices in an in-vivo environment provides a more realistic simulation of critical vessel viscoelastic and physiologic responses. In comparison, in-vitro and cadaveric models, though indispensible, can only assess structural and mechanical responses. Replicating the tortuosity of the carotid siphon in an in vivo model is a challenging endeavor. Models created by complex surgical maneuvers have previously been described1, often requiring the expertise of a skilled surgical team and considerable expense. We describe a novel porcine model of arterial tortuosity with a quantitative comparison of its geometric features with a population representative carotid siphon acquired from a patient dataset.Materials and MethodsThree Yorkshire swine (sex: male, mean weight 46.6 kg) were used for the purposes of the study. The animals were anesthetized and femoral artery access was obtained through a 6F sheath. The microcatheter was successfully navigated to the brachial branch of the axillary artery and a selective digital subtraction angiogram was acquired in both extended and flexed right and left forelimb positions. Three dimensional rotational angiograms (3DRA) were also acquired. The vessel segmentation and centerline was generated using Mimics (Materialise, Leuven, Belgium) and a quantitative measurement of the geometric parameters was obtained as previously described. This was compared with a realistic population representative human carotid siphon model.2ResultsThe mean average curvature (AC), length and diameter calculated for the arterial segments (average±SE of the mean) in the extended (0.28±0.06 mm−1, 13.99±1.66 mm and 2.60±0.19 mm) and the flexed (0.29±0.02 mm−1, 17.59±0.77 mm and 2.59±0.12 mm) position are similar. In comparison, the values calculated for the population representative carotid siphon are 0.34±0.02 mm−1, 22.60±0.79 mm and 4.15±0.09 mm, respectively. However, positioning the forelimb in the flexed position (Abstract O-023 figure 1A, arrows) increased the number of tortuous bends in comparison to the extended position (Abstract O-023 figure 1B, arrow).Abstract O-023 Figure 1ConclusionWe have described a reproducible in vivo model of arterial tortuosity in the brachial artery in the flexed forelimb position in the swine. This model offers a challenging target for the assessment of guidewires, microcatheters and endovascular implants since it closely mimics the curvature experienced at the carotid siphon.
P-012 A mathematical model of vascular tortuosity using optimality analysis
Authors: Hathout L , Do H 
Published: July 2011

Introduction/PurposeAlthough vascular tortuosity is a ubiquitous phenomenon, no mathematical models exist to describe its shape. Given that the shape of tortuous vessel curves seems fairly uniform across great variations in vessel size and anatomic substrata, it is hypothesized that tortuosity is not purely random, but is governed by physical principles. We develop a mathematical model based on optimality principles, and show how it can potentially be used to distinguish physiologic from abnormal tortuosity.Materials/MethodsA model is developed which minimizes average curvature per unit length; it produces a “sine-generated” curve. Thirty-four tortuous vessel segments (from retinal, superficial temporal, coronary and splanchnic vessels) are analyzed and compared to the results of the model. Curve shapes are characterized by the parameters L/R and L/l, where L is curve length, l is wavelength, and R is radius of curvature. These parameters are measured for each vessel segment and calculated for the corresponding theoretical curves. The accuracy of the model is compared with that of a standard sine curve in trying to model vessel tortuosity. Also, six retinal vessel segments from a case of Fabry's disease (which produces abnormal tortuosity) are analyzed and compared to the model.ResultsComparison between measured and predicted values produces average percent errors of 5.8% in L/R and 5.5% in L/l. Also, sine-generated curves produce a significantly better fit than standard sine curves (p=0.001). For the case of Fabry's disease, there is a significant deviation from the theoretical model, with average percent errors of 21% in L/l and 33% in L/R.ConclusionsThe theoretical model provides a good fit for normal vessel tortuosity. This suggests that blood vessels obey optimality principles, and curve in such a way as to minimize average curvature. This makes physical sense, as it would minimize shear stress against vessel walls and the energy needed to accelerate blood through the vessel. Although anecdotal, the case of Fabry's disease differed significantly from theoretical results, suggesting that these vessels deviate from the normal pattern of tortuosity. The model may be useful in distinguishing physiologic tortuosity from the abnormal tortuosity which may occur in disease states.Abstract P-012 Figure 1
P-018 A novel new large lumen/hyper flexible intracranial access and aspiration device: preliminary animal study and initial clinical experience
Authors: Tateshima S , Pereira V Mendes , Lopez D 
Published: July 2011

PurposeTo evaluate the performance of a new large lumen//hyper flexible intracranial access and aspiration device (ReFlexTM, Reverse Medical, Irvine, California, USA) for endovascular use in a swine thrombo-embolic model, cadaver model, and initial clinical settings, and to compare its efficacy to other available devices.MethodWe investigated the use of Reflex 058 and 072 devices for endovascular access and focal thrombus aspiration treatment in a swine model, cadaver model, and initial clinical settings. These new devices employ a combination of Nitinol and a special tertiary polymeric composite which results in a larger lumen, thin walled device, possessing extreme flexibility and kink resistance. 10 carotid artery branches (lingual, maxillary, or ascending pharyngeal) in swine were prepared with prophylactic papaverine and occluded with radiopacified blood thrombi. Once the occlusion was confirmed, ReFlex or a control device was advanced proximal of the target thrombi. Only localized aspiration was applied through the ReFlex or control device. No flow arresting means were utilized. Parameters collected for this assessment study were the ability to access target vessels, TICI score, number of aspiration attempts, % clot retrieved, and thrombus fragmentation and/or thrombus loss at the tip of the device. Since the swine model is much less tortuous than humans, a perfused cadaver model was utilized to confirm intracranial accessibility performance against control devices. Initial clinical evaluations were performed in conjunction with commercially available mechanical thrombectomy devices.ResultWe found slightly better TICI scores, and % clot retrieved with ReFlex, and superiority over the control devices in the ability access distal anatomy within both the swine and cadaver models. No vessel dissections or device failures were encountered during this study. Additionally, histopathologic safety testing was conducted, and revealed lower intimal damage compared to the control devices. Lastly, since ReFlex device has a slightly larger lumen over the control devices, the ability to injection contrast was noticeable easier. Initial clinical use demonstrated the devices ability to aspirate thrombus in conjunction with mechanical thrombectomy devices. Initial clinical use demonstrated aspiration thrombus capabilities from the middle cerebral artery territories.ConclusionLarge lumen, hyper flexible ReFlex device is an effective tool for the treatment of acute stroke as an aspiration device and coaxial supporting catheter.Abstract P-018 Figure 1
P-023 Endovascular treatment of tandem occlusions of the anterior cerebral circulation
Authors: Machi P , Lobotesis K , Maldonado I , Bonafe A 
Published: July 2011

Background and purposeThe optimal treatment in the acute phase of cervical internal carotid artery (CICA) occlusion associated with carotid “T” or middle cerebral artery obstruction is a matter of debate. In this study, we report our experience using endovascular mechanical thrombectomy and synchronous intravenous fibrinolysis.Patients and Methodswe examined all cases of tandem occlusion treated in our institution between November 2009 and November 2010. The proximal occlusion was treated using manual thromboaspiration without stenting in order to achieve intracranial recanalization as rapid as possible. When necessary, stenting was performed after the reconstitution of the intracranial vessel. Morphological and clinical results were recorded in the immediate post-operative phase and at the 3-month follow-up. Clinical success was defined as final NIHSS=1 or improvement of ≥10 points from the baseline score.ResultsFour men and six women were treated (mean age 66 years). Three patients underwent standalone MTB because of contra-indications to intravenous fibrinolysis. The cervical internal carotid artery was recanalized in all cases and the intracranial vessel (TICI≥2b) in eight. Adverse events were recorded in four patients of which three were asymptomatic. These included 2 cases of subarachnoid hemorrhage, one case of traumatic dissection and collateral artery embolism, and one case of fatal intra-cerebral hemorrhage 7 days after the procedure. At the 3-month follow-up a mRS≤2 was observed in four patients.ConclusionThe described approach for the treatment of tandem occlusions is effective with regard to morphological and clinical assessments and thus may be considered as a valid tool in acute stroke.
P-027 Management of intracranial artery dissections with stents: a series of 49 patients
Authors: Alexander M , Choulakian A , Chowdhary A , Schievink W 
Published: July 2011

IntroductionArterial dissections may be spontaneous or related to trauma, and patients with certain conditions, such as fibromuscular dysplasia or collagen vascular diseases, may be more pre-disposed to develop dissections. Arterial dissections in the intracranial vasculature are relatively rare and are less likely to be traumatic. When they do occur, they may lead to ischemic or embolic symptoms when there is a dissection flap or stenosis, or to subarachnoid hemorrhage or discovery of a non-ruptured, dissecting intracranial aneurysm.MethodsThis was a retrospective analysis of a prospectively collected database of patients with intracranial arterial dissections, who were treated with intracranial stents by a single operator over 11 years, without or with coil embolization. Patient presentation, procedural results, type of stent, clinical outcome, and delayed imaging findings were reviewed. In cases of dissection with an intimal flap, stenting alone was performed. In patients with dissecting aneurysms, a stent was used in all cases, and only those cases that had a significant saccular component had the placement of coils, in addition to the intracranial stent.ResultsA total of 49 patients were treated with intracranial arterial dissections. 19 of the patients presented with a dissection flap and arterial narrowing, 27 presented with a dissecting aneurysm (14 with subarachnoid hemorrhage and 13 with non-ruptured aneurysms), and three patients had a dissecting aneurysm and vessel narrowing. The average patient age was 34 years of age. The dissection location included 21 intracranial internal carotid artery (ICA), 12 vertebral artery, 6 posterior cerebral artery, 5 middle cerebral artery, 4 basilar artery, and 1 anterior cerebral artery. Patients were more likely to present with subarachnoid hemorrhage with ICA or vertebral artery dissections, and patients were more likely to present with ischemic symptoms with middle cerebral artery or basilar artery dissections. There were two thromboembolic complications (4%) related to the embolization procedure, there was one subsequent re-hemorrhage (2%) in a patient with a ruptured, blister-type, dissecting ICA aneurysm, and 1 groin access complication. Of the 30 patients who had an associated dissecting aneurysm, imaging follow-up was available in 25 patients. Of these, the recurrence rate was 20% (5 aneurysms), and all five were re-treated.ConclusionsStenting without or with coils is an effective treatment option for patients with intra-cranial arterial dissections. We recommend treatment in patients with dissection flaps that are enlarging on imaging or refractory to medical therapy, and in patients with dissecting intracranial aneurysms, due to the high rate of subarachnoid hemorrhage. Our overall complication rate was 8% for treatment, and there was a high propensity for aneurysm re-growth, with a 20% re-treatment rate.
P-031 Endovascular treatment in young adults with acute ischemic stroke: a single center experience
Authors: Mehta S , Sharma J , Masoud H , Chowdhry S , Nanda A , Sila C , Blackham K 
Published: July 2011

ObjectiveTo assess the safety and efficacy of different endovascular treatment modalities in young adults with acute ischemic stroke (AIS).BackgroundStroke in young adults is less common compared to the elderly but forms a significant burden in terms of morbidity and mortality. Endovascular therapies for AIS are relatively new modalities showing great promise. Data regarding their efficacy in this population is scant.Design/MethodsRetrospective chart review was performed in 188 consecutive patients who underwent endovascular treatments for acute ischemic stroke at our center between 2005 and 2009, and the patients between the ages of 18–45 were selected for further review (n=11). Their demographics were studied and the outcomes measured were post intervention rates of recanalization, asymptomatic and symptomatic hemorrhages and mortality.ResultsOf the 11 patients age 18–45 (mean age 38.63±8.26), 54%(n=6) were female, 27.2% (n=3) were hypertensive and 9% (n=1) patients were diabetic. The mean NIHSS on admission was 15 and that on discharge was 6.5. The majority of the patients (n=9) had lesions in the anterior circulation, 5 of which were in the internal carotids, 2 were proximal MCA and 3 were distal MCA (M2/M3) branches. Vertebral and basilar artery occlusions were found in one patient each. All of these patients received a combination of intravenous and intra-arterial tPA. In addition, three patients received mechanical thrombectomy with MERCI (n=2) or Penumbra (n=1) retrieval devices. Complete recanalization (TIMI 3) was achieved in 27.2% (n=3) patients; partial recanalization (TIMI 2) was achieved in 54.5% (n=6) patients and no recanalization in 18.1% (n=2) patients. 18.1% (n=2) patients had asymptomatic and none(n=0) of the patients had symptomatic intracerebral hemorrhages detected on follow-up CT scans at 24 h post procedure.There were no mortalities.ConclusionsCombined intravenous and endovascular therapies proved to be a relatively safe and efficacious treatment modality for young patients with acute ischemic stroke, and these patients tended to have better outcomes than those reported for the general population.
E-007 Spontaneous post-partum cervical carotid artery dissection in a patient with reversible cerebral vasoconstriction syndrome
Authors: Soltanolkotabi M , Ansari S , Shaibani A , Singer T , Hurley M 
Published: July 2011

Postpartum cervicocephalic artery dissection (pp-CAD) is a rare and poorly understood condition. To our knowledge, only 21 cases have been reported. Reversible cerebral segmental vasoconstriction was first described by Call and Fleming in 1988, and its association with pp-CAD has only been reported in three cases. However, in those cases it is unclear whether the pp-CAD may have been caused by straining during labor and therefore merely coincidental to the intracranial arteriopathy. We report a 42-year-old right handed African-American woman who developed the syndrome of pp-CAD (headaches, trace sub-arachnoid hemorrhage and diffuse cerebral arteriopathy on angiogram) 2 weeks after delivery. In this unique case, the patient had fortuitously undergone an MR study twice over a 4-day period which included the carotid bifurcations. During that time the patient was an inpatient, on bed rest and subject to continuous cardiac monitoring. The interval studies documented a true spontaneous right internal carotid artery dissection occurring without obvious cause. The patient had noted moderate right neck pain developing between the two MR studies but experienced no neurological deficits. Subsequent conventional angiography confirmed the presence of postpartum cerebral arteriopathy and the cervical dissection. The patient was managed conservatively with antiplatelet medication and had an otherwise uneventful course. We hypothesize whether transient arterial wall abnormalities, postpartum hormonal changes or subtle connective tissue aberrations play a similar role in the pathogenesis of these two associated conditions.Abstract E-007 Figure 1Image A: Angiogram of the right carotid bifurcation demonstrates a focal stenosis (arrow) of the right ICA distal to the bulb due to an incompletely thrombosed dissection with partial opacification of the pseudo-lumen origin (arrowhead). Image B: Cerebral angiogram shows multifocal arteriopathic beading in all territories (arrows).
E-019 Preoperative cortical localization by magnetic source imaging for endovascular treatment of arterial venous malformations in eloquent brain tissue
Authors: Cho A , Pakbaz S , Bykowski J , Green D , Lee R 
Published: July 2011

IntroductionPreoperative localization of functionally eloquent brain tissue helps plan and tailor the extent of endovascular embolization and surgical resection of AVMs. Combined magnetoencephalography and MR data can be used to localize functional somatosensory, auditory, and motor cortical organization.Materials and MethodsRetrospective review of all AVMs treated (both endovascular and surgical) at our institution over the past 2 years. We identified 4 cases of AVMs involving eloquent cortical brain tissue with associated magnetic source imaging for localization of cortical organization. Case records were reviewed for patient outcome and impact of cortical organization localization of treatment and management.ResultsCombined magnetoencephalography and MR data had a high degree of reliability in localizing motor cortex in areas adjacent to and incorporated by AVMs. Localization of motor cortex affected AVM treatment plans focusing on preservation of motor cortex function.ConclusionFunctional mapping of the cortex is indispensable for optimal treatment of AVMs involving eloquent brain tissue. The cases outlined demonstrate the capability of preoperative spatiotemporal functional brain mapping using MEG.
E-020 Endovascular treatment of cranio-cervical vascular trauma
Authors: Le Feuvre D 
Published: July 2011

IntroductionCranio-cervical trauma carries a high morbidity and mortality. Because of the vital structures and inaccessibility surgical treatment of these injuries is often high. Endovascular intervention lends itself to the treatment of vascular injuries. This in mind we reviewed our endovascular treatment of cranio-cervical injuries over a 1-year period.MethodsBetween September 15, 2008 and September 14, 2009 we reviewed the patients we had been asked to treat endovasculary by the trauma surgeons or who had been referred directly to our neurosurgical unit. The demographic profile and the mode of injury was reviewed and the vascular injury was anatomically and pathologically assessed using the DSA. Next the specific treatment for the different vascular injuries was reviewed.ResultsWe identified 22 patients 64% sustaining penetrating injuries and 36% from blunt trauma. 50% of the injuries were false aneurysms, 36% CCFs, 9% were AVFs and 5% were dissections. Treatment used balloons, glue or coils depending on the injury. There was one asymptomatic complication.ConclusionsEndovascular treatment offers a viable safe and often better alternative to surgical injuries to cranio-cervical injuries.
Observations regarding the flight biology and behaviour of the Common buzzard (Buteo Buteo) in the Râul Doamnei hydrographical basin (Romania)
Authors: Mestecăneanu Adrian , Mestecăneanu Florin 
Published: July 2011

Observations regarding the flight biology and behaviour of the Common buzzard (Buteo Buteo) in the Râul Doamnei hydrographical basin (Romania)
In this paper, the authors analyse the flight biology and behaviour of the Common buzzard (Buteo buteo) observed in the Râul Doamnei hydrographical basin, depending on the environmental conditions and ecological seasons. Along three years, during the 3031 observations, 4549 individuals were observed.
ChemInform Abstract: Self‐Assembled 3D Flowerlike Hierarchical Fe3O4@Bi2O3 Core—Shell Architectures and Their Enhanced Photocatalytic Activity under Visible Light.
Authors: Wang Yang , Li Shikuo , Xing Xianran , Huang Fangzhi , Shen Yuhua , Xie Anjian , Wang Xiufang , Zhang Jian 
Published: June 2011

AbstractThree‐dimensional flowerlike hierarchical Fe3O4@Bi2O3 core—shell particles are solvothermally synthesized from Bi(NO3)3 and magnetic Fe3O4 nanoparticles in a mixture of ethylene glycol and EtOH (autoclave, 160 °C, 5 h).
ChemInform Abstract: χ‐Octamolybdate [MoV4MoVI4O24] 4‐: An Unusual Small Polyoxometalate in Partially Reduced Form from Nonaqueous Solvent Reduction.
Authors: Wang Longsheng , Yin Panchao , Zhang Jin , Hao Jian , Lv Chunlin , Xiao Fengping , Wei Yongge 
Published: June 2011

AbstractThe reduced octamolybdate (II) crystallizes in the triclinic space group P$\bar 1$ with Z = 2 (single crystal XRD).