bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-047 Aneurismal thrombosis post coil introduction in a rat aneurysm model: correlation of MRI findings with histopathology
Authors: Elias A , Zhang C , Pandey A , Guoua X , Gemmete J , Chaudhary N 
Published: July 2012

IntroductionMRI plays a significant role in the post embolization follow-up of patients who have undergone coil embolization of cerebral aneurysms. We have utilized a rat aneurysm model to study the aneurysm healing process. Based on the extrapolation of signal characteristics of endovascular thrombus in humans, we have determined that gradient echo sequences (T2* weighted images) would be the optimal method to quantify amount of endoluminal thrombus. We aim to correlate the MRI findings with histopathological findings in this experimental rat aneurysm model.MethodsThis experimental aneurysm study in a rat model was approved by the University Committee on Use and Care of Animals. Male Sprague Dawley rats were anesthetized with transperitoneal injection of 50–60 mg/kg pentobarbital. In each animal an artificial aneurysm was created by permanent ligation of the rat external carotid artery (ECA) 5 mm from the carotid bifurcation (ECA blind pouch aneurysm). Subsequently a 5 mm coil segment was inserted into this aneurysm by an arteriotomy and then a ligature was placed proximal to the arteriotomy. Five rat aneurysms were treated with platinum coils and five others were treated with hydrocoils. 14 days post-treatment, animals underwent MRI analysis of the treated aneurysms as well as being sacrificed for histopathological analysis. The volume of the thrombus formation was calculated by measuring the maximal area (ROI) of blooming artifact × slice thickness (mm)/matrix (256) using NIH Image J software version 1.43U. The histological specimens were studied under high-field microscope and thrombus formation was demarcated following staining. Measurements were performed on the MR images and histological specimens independently in a blinded fashion. The measured values on MRI and histological sections were then analyzed using the Pearson correlation coefficient (PCC) by SPSS V.15.0.ResultsOur results demonstrate a significant correlation between the extent of luminal thrombus formation on histology and signal characteristics on T2* GRE MRI sequences when the rats were treated with bare platinum coils PCC=0.987 (p=0.002). The hydrogel coated coils did not show MR correlation with area of thrombus formation PCC=0.344 (p=0.571).ConclusionWe report the first correlation extent of luminal thrombus formation on histology with signal characteristics on T2* GRE MRI sequences in a rat aneurysm model. Our hypothesis of direct correlation between the above mentioned variables holds true in the bare platinum coil group and not in the hydrocoil group. Such positive correlation could allow for non-invasive evaluation of treated experimental aneurysm models.Competing interestsNone.
P-005 A novel three-dimensional (3D) revascularization device: histopathology results from a rabbit model and early clinical experience with the penumbra separator 3D
Authors: Weber J , Jansen O , Rohr A , Knauth M , Schramm P , Grand M , Weber W , Loehr C , Doerfler A , Struffert T , Goelit P , Zimmer C , Prothmann S , Boeckh-Behrens T 
Published: July 2012

Introduction/PurposeWe report on the histopathology results from a preclinical rabbit study and our early clinical experience with the Separator 3D device, featuring novel 3D chambers for securing and removing thrombus. Compatibility with differently sized catheters provides flexibility to combine with aspiration.Materials and MethodsTo evaluate vascular responses of multiple 3D deployments and resheathings, a rabbit elastase model study examined right and left subclavian arteries from five rabbits 30 days after eight cycles. Vessels were subjected to histopathology analysis. Case experience in six European centers was collected in the first 30 days post-device approval. Fourteen consecutive patients presenting with acute ischemic stroke within 8 h of symptom onset were treated with the 3D device. Five cases involved ICA to MCA (M1 or M2) occlusion; four involved M1 segmental occlusion; two involved M1 to M2 occlusion; one involved basilar to PCA occlusion; two were excluded due to underlying stenosis. In the two cases involving stenosis, use of the 3D device followed by other stent retrievers like Solitaire (Covidien), Trevo (Stryker), and Restore (Reverse Medical) could not achieve revascularization; they were eventually resolved by balloon or stent.ResultsMultiple 3D deployment and resheathing cycles in the rabbit revealed no histopathologic lesions at 500 μm magnification nor evidence of injury or inflammation in the internal elastic lamina. Notably, no intraluminal fibrin or thrombus was found. In a multi-center case review study, the 3D device achieved 92% revascularization to TICI 2B or 3, excluding stenotic cases. In all cases, the 3D was successfully delivered to the occlusion site resulting in successful recanalization with 1.5 average passes. No vessel injury, vasospasm, or embolization of new territory was observed.ConclusionPreliminary results demonstrate that the Penumbra Separator 3D is a safe, effective revascularization device. Early animal and clinical experience with the 3D device appears promising. Absence of vessel injuries or new territory emboli may be aided by intraluminal 3D chambers that engage and remove clot with aspiration applied close to the lesion site. Smooth delivery and easy handling of the 3D was noted even in highly tortuous anatomy. Further case experience is warranted to confirm these promising initial observations.Competing interestsNone.
P-006 Angiographic and clinical outcomes after endovascular therapy for acute ischemic stroke due to vertebrobasilar occlusions: pooled analysis of the Merci Registry, MERCI, and multi MERCI trials
Authors: Nogueira R , Jovin T , Smith W , Rymer M , Liebeskind D , Budzik R , Devlin T , Walker G , Lutsep H 
Published: July 2012

ObjectiveTo describe the results of endovascular thrombectomy in a large prospective cohort of Acute Basilar Artery Occlusion (BAO) patients.BackgroundBAO is a serious but uncommon condition accounting for only 6%–10% of large-vessel strokes.Design/MethodsOur cohort included all BAO patients from three different prospective thrombectomy studies - the MERCI trial, the Multi MERCI trial, and the MERCI Registry. Successful recanalization was defined as TIMI 2–3 in the Merci/Multi-Merci trials and TICI 2–3 in the Merci Registry. Good Outcomes was defined as 90-day mRS 2.ResultsNinety-nine patients were identified (mean age, 61.6±15 years (range, 31–93); male gender, 70.7%; mean baseline NIHSS, 20.5±9.4 (median, 19); baseline mRS0-1, 95.9%). Fourteen patients (14.1%) received pre-procedure IV rt-PA. The mean time-from-symptom-onset (TSO) to arterial puncture was 9.23±12.45 h (median, 6.15) with 34.1% of patients treated >8 h. All patients were treated with at least one pass of Merci (average, 2.3±1.6). Other treatments included: intra-arterial rt-PA/urokinase (53.5%), proximal angioplasty (22.1%, 19/86) or stenting (14.0%, 12/86), Penumbra (15.3%, 11/72), and other mechanical (29.1%, 25/86). Successful recanalization was achieved in 88.9% (88/99). The overall mean (median) NIHSS dropped from 20.5±9.4/19 on admission to 13.4±14.5/6 on discharge. The overall rate of good outcomes was 31.6% (31/98). 90-day mortality was 38.8% (38/98). The SICH rate was 8.9% (7/79). The rate of good outcome was numerically higher (34.5% vs 9.1%) and mortality was numerically lower (36.8% vs 54.5%) in the revascularized vs non-revascularized patients. Notably, only one of 31 (3.2%) patients achieved a good outcome in the absence of recanalization. Patients with good outcome had significantly lower age (56.6 vs 63.6), baseline NIHSS (14.86 vs 23.15), and hypertension (51.6% vs 73.1%) but higher baseline functional status (mRS 0–1, 100% vs 93.8%) as compared to patients with bad outcomes. However, there was no difference in terms of TSO to puncture (9±13 vs 9±13 h), glucose levels (130±27 vs 152±62 mg/gl), intubation (82.6% vs 90.4%), or treatment modalities between these two groups.ConclusionsMechanical thrombectomy in BAO appears to be associated higher recanalization rates than previous reports of intravenous or intra-arterial thrombolysis. In concordance to previous studies, the chances of good outcomes are dismal in the absence of recanalization.Competing interestsR Nogueira: Concentric Medical, Inc., ev3 neurovascular, Coaxia, Rapid Medical. T Jovin: Concentric Medical; ev3 neurovascular; Coaxia. W Smith: Concentric Medical. M Rymer: Genetech. D Liebeskind: Concentric Medical; Coaxia. R Budzik: Concentric Medical. T Devlin: None. G Walker: Concentric Medical, Inc. H Lutsep: Concentric Medical.
P-009 Endovascular balloon-augmented embolization of intracranial and cervical arteriovenous malformations using a dual lumen coaxial balloon microcatheter: initial experience: Abstract P-009 Figure 1
Authors: Grigoryan M , Hassan A , Tummala R , Tekle W , Seidel G , Jagadeesan B 
Published: July 2012

BackgroundTransarterial embolization with ethylene vinyl alcohol copolymer (EVOH) Onyx (ev3, Neurovascular, Irvine, CA) is a popular method for endovascular management of arteriovenous malformations (AVMs) and fistulas. Successful embolization depends on antegrade flow of Onyx following initial formation of a proximal plug. Plug formation can be unpredictable, time consuming and can result in catheter retention. To avoid the need for forming a proximal plug, we recently adopted Onyx embolization through a coaxial balloon microcatheter.MethodsWe performed a series of five consecutive Onyx embolizations via seven arterial feeders in four patients using the Scepter C (Microvention Inc, Tustin, CA), a coaxial balloon catheter with an inner lumen for a guidewire and an outer lumen for balloon inflation/deflation. In each case, the catheter was navigated into the feeding artery over an 0.014 wire. After removing the wire, the balloon was then carefully inflated to arrest the flow and prevent reflux of Onyx. The inner lumen was primed dimethyl sulfoxide and Onyx 18 or 34 was then infused under continuous fluoroscopic visualization. Embolizations were terminated following adequate penetration of the AVM nidus. The balloon was then deflated and catheter was slowly removed without difficulties.ResultsThe balloon catheter showed excellent navigability and there were no complications involving its inflation, deflation, or retrieval. There was no reflux of Onyx. Excellent penetration into the AVM nidus was achieved during all sessions. No untoward embolization into the normal cerebral circulation has occurred. None of the patients suffered peri- or postprocedural complications.ConclusionsOnyx embolization via a coaxial lumen Scepter C balloon catheter allows for great penetration while obviating the need for the usual “plug and push technique”. It reduces procedure time and radiation exposure. Due to its current availability in only one size (4 mm), the technique may be safest in larger diameter arterial feeders.Competing interestsNone.Abstract P-009 Figure 1
E-010 Preoperative embolization of meningioma with dural branch of internal carotid artery
Authors: Hirohata M , Takeuchi Y , Sakata K , Marioka M 
Published: July 2012

PurposeOne of the most important issues in the surgical treatment of large hypervascular meningiomas is the securing and coagulation of feeding arteries. However, securing the feeding artery prior to actual tumor resection might be difficult in tumors with a feeding artery arising from the deep surface of the operative field. For such cases, we performed selective feeder embolization before tumor resection. This study evaluated the clinical usefulness of preoperative embolization of the dural branch of the internal carotid artery (ICA) for brain tumor.Clinical materialSubjects comprised 21 consecutive patients with large hypervascular meningioma fed by ICA dural branche (Meningohypophyseal artery: 14, Infero-lateral trunk: 9, Ethomoidal Artery: 1) Feeder embolizations were performed under local anesthesia 1 day before tumor resection. 2 or 1.7 F microcatheter and hydrophilic shapable micro guide wire and PVA (150–250 μ) were used.ResultsMaximum tumor size were 30 to 72 (mean: 45.9) mm Almost complete embolization was obtained in nine patients, and a marked decrease in tumor staining was demonstrated in 13 patients. No complications related to endovascular procedures were encountered. Intraoperative control of bleeding was easily manages, with mean intraoperative blood loss of 536 ml. Although partial resection was possible due to cranial nerve adhesion to the tumor in two cases, total or sub total resection was achieved in 19 cases.ConclusionEndovascular embolization of the feeding artery from ICA dural branch was safe and effective adjuvant therapy before tumor resection.Competing interestsNone.
E-013 Coil herniation and retinal/vitreous hemorrhage in a patient with antiphospholipid antibody syndrome undergoing balloon assisted coil embolization of unruptured ICA aneurysm: Abstract E-013 Figure 1
Authors: Gupta V , Gandhi C , Prestigiacomo C , Bhagat N , Turbin R , Gupta G 
Published: July 2012

Antiphospholipid antibody syndrome (APS) is a well-recognized cause of hyper coagulation causing arterial/venous thrombosis and/or pregnancy morbidity. Thromboembolic complications remain the main concern during endovascular coil embolization of aneurysms. Retinal and vitreous hemorrhages in association with this syndrome as a post coiling complication of unruptured intracranial aneurysm has not been previously reported. We report the case of a 48-year-old woman with underlying APS who underwent balloon assisted coil embolization of an unruptured right ICA aneurysm. There was herniation of the second coil requiring coil retrieval with subsequent non flow limiting herniation of the first coil left in situ on anticoagulation. In the immediate post procedure period, she developed preretinal, intraretinal and vitreous hemorrhages requiring temporary withholding anticoagulation therapy with careful resumption. Retinal/vitreous hemorrhages in a patient with APS presents a complex management challenge in the context of a herniated coil loop during endovascular aneurysm therapy.Competing interestsNone.Abstract E-013 Figure 1
E-014 Endovascular occlusion of trigeminal artery-cavernous fistula following spontaneous rupture of a persistent trigeminal artery (PTA): technical considerations and case report: Abstract E-014 Figure 1
Authors: Fortes M , Jindal G , Gomez J , Gandhi D 
Published: July 2012

PurposeTo report a rare case of spontaneous rupture of dysplastic trigeminal artery in the cavernous sinus, imaging findings and technical considerations for treatment with vessel preservation.Case reportA 47-years-old female presented to the emergency department with acute onset of left eye pain, redness, elevated intra-ocular pressure and left third nerve palsy.Imaging findingsCT angiography obtained at admission showed a dilated left cavernous sinus and a suspicion that there may be ipsilateral PTA. Digital subtraction angiogram (DSA) of the left internal carotid artery (ICA) demonstrated a very high flow carotid-cavernous fistula but the exact location of the tear was impossible to find on anterior circulation injection. An analysis of left vertebral injection, 3D-DSA and DynaCTTM demonstrated and mapped the location of the tear in proximal PTA. Vessel preservation was considered necessary since the left anterior inferior cerebellar artery arose from the PTA. Dual catheter access was obtained (left ICA and left vertebral) and the fistula catheterized from the basilar artery aspect of the PTA. Additional micro-catheter was placed across from left ICA into PTA across the tear in case a stent would be necessary to reconstruct the PTA. Complete coil occlusion of the fistula could be accomplished and stent was not required. The patient recovered fully from this fistula and 3rd nerve function was normal at 2-weeks follow-up.SummaryPersistent trigeminal artery is an anatomic variant seen in 0.1%–0.6% of cerebral DSAs. Although a handful of cases of PTA related carotid-cavernous fistula are reported in the literature, a determination that the tear was spontaneous and not related to underlying aneurysm is difficult or impossible. Our case demonstrates the utility of careful imaging in the angiography suite with the inclusion of DynaCTTM and simultaneous dual catheter (ICA and Vertebral) 3D imaging for evaluation. A well-planned endovascular approach is key when preservation of the parent vessels with closure of the fistula is the goal.Competing interestsNone.Abstract E-014 Figure 1(A) Coronal reconstruction from DynaCT shows left cavernous ICA (short black arrow), PTA (long black arrow) and carotid cavernous fistula (white arrow). (B) Left ICA coronal view DSA shows intense early venous drainage to the cavernous sinus.
E-020 Initial multi-center international experience with the target detachable coil
Authors: Turk A , Machi P , Chaudry M , Bonafe A , Turner R 
Published: July 2012

BackgroundAneurysm coil technology has evolved to require near instant detachment times and near perfect detachment performance. We evaluated the new Target coil to determine device safety and acute performance.Materials and MethodsAt two large high volume international centers, between November 2010 and February 2012, 211 aneurysms were coiled with Target coils; 127 elective and 84 ruptured. Average aneurysm dimensions were 5.51 mm × 4.01 mm × 3.89 mm with 17% PCOM, 21% ICA, 31% ACOM and the remaining Basilar, MCA and Vertebral. 62% of the cases were treated with balloon assisted coiling, 5% were stent assisted coiling, and 7% utilized both balloons and stents. 77% of the cases achieved a Raymond Scale of 1, 21% achieved a Raymond scale of 2, and 1.5% were Raymond Scale of 3. We experienced a 5% procedural complication rate, of which 4% were thromboembolic. There was one vessel injury related to balloon remodeling, one vessel perforation retrieving an errant coil and one perforation during coiling. Detachment times were evaluated in the first 26 cases utilizing 11 coils and showed all coils detached, with 90% in the first cycle. The original detachment time was 7.1 s. The detachment handle was altered to shorten the detachment cycle after the first 44 coils. The detachment time was then found to be 5.7 seconds for the last 67 coils. We continue to use the coils and will update results at time of the meeting.DiscussionThe new Target coil combines the device performance of the GDC coil with an advanced pusher wire and detachment mechanism that allowed rapid and reliable coil performance. This can translate into faster operating times with improved device performance resulting in safer operations and better clinical outcomes.Competing interestsA Turk: Stryker. P Machi: None. M Chaudry: None. A Bonafe: None. R Turner: None.
E-021 Initial experience using the Penumbra Coil 400: comparison of aneurysm packing and coil efficiency
Authors: Milburn J , Pansara A , Martinez R , Vidal G 
Published: July 2012

IntroductionPenumbra Coil 400 gained FDA approval and was introduced to the market April 2011. Due to its larger 0.020″ diameter and inherent softness, there is potential to provide more efficient coiling. More efficient coiling may result in shorter catheter in vessel time and less radiation exposure for the patient and healthcare team. This is a retrospective single operator experience of aneurysm coiling at the Ochsner Clinic comparing the Penumbra Coil 400 with the other most commonly used coil types, Orbit and Galaxy.MethodsForty aneurysms treated exclusively with Orbit or Galaxy coils and 18 aneurysms treated only with Penumbra coils from 2010 to February 2012 were compared. There were 36 other aneurysm treatments excluded because they were not initial treatments, other manufacturers' coils were used, or they had mixed coil types. Measurements included packing density, number of coils per unit aneurysm volume, and total coil length per unit aneurysm volume. Other parameters including presenting aneurysm rupture status, frequency of stent or balloon use, aneurysm occlusion rates, and complications were also compared.ResultsMean packing density of 33.7% using Penumbra coils was significantly >24.4% for Orbit/Galaxy coils (p=0.0001). Number of coils per aneurysm volume of 0.026 coils/mm3for Penumbra was significantly lower than 0.114 coils/mm3for Orbit/Galaxy (p<0.001). Total coil length per aneurysm volume of 0.11 cm/mm3for Penumbra was significantly <0.32 cm/mm3for Orbit/Galaxy treatments (p<0.001). Aneurysm sizes ranged from 6.3 mm3to 5564.0 mm3in the Orbit/Galaxy group and from 31.0 mm3to 12 666.4 mm3in the Penumbra group. There were more ruptured aneurysms treated using Orbit/Galaxy (67%) than with Penumbra (28%). Aneurysm occlusion rates and frequency of balloons or stent use was similar in both groups. There were no procedural complications in the Penumbra cases, and there were two small branch infarctions in the Orbit/Galaxy group that were not clinically apparent.ConclusionIn our practice, aneurysm treatments with the Penumbra 400 coil have resulted in significantly greater average packing density using less than one fourth of the number of coils per volume compared with Orbit/Galaxy. Aneurysms were larger in the penumbra group, and more ruptured aneurysms were treated with Orbit/Galaxy. Occlusion rates and complication rates were similar and acceptable in both groups.Competing interestsJ Milburn: Penumbra. A Pansara: None. R Martinez: None. G Vidal: None.
E-022 Tandem symptomatic internal carotid artery and persistent hypoglossal artery stenosis treated by endovascular stenting and flow reversal: case report: Abstract E-022 Figure 1
Authors: Eller J , Jahshan S , Dumont T , Kan P , Levy E , Siddiqui A 
Published: July 2012

The persistence of the hypoglossal artery (PHA) into adulthood is a very rare vascular anomaly and, when present, provides the only vascular supply to the posterior circulation. We describe a case of a 64-year-old male presenting with symptoms of vertebro-basilar insufficiency associated with severe high grade stenosis of a persistent hypoglossal artery and tandem stenosis of the proximal ipsilateral internal carotid artery (ICA), both treated by an endovascular approach. Given this patient's comorbidities and the potential anatomic difficulties presented by the PHA during performance of a carotid endarterectomy, we decided to proceed with stent placement in both the proximal ICA and the PHA in the same treatment setting. The high degree of stenosis in the PHA and the presence of a large atherosclerotic plaque in the proximal ICA were felt to be good indications for proximal embolic protection by a flow-reversal technique using the GORE Flow Reversal System (W.L.Gore and Associates, Inc., Flagstaff, AZ). The unique anatomical and technical challenges associated with this case are reviewed in detail. Post-operatively, the patient improved clinically, remaining with minimal subjective right sided numbness and he was discharged home on ASA, Effient and Crestor. The patient had no complications related to the endovascular procedure.Competing interestsJ Eller: None. S Jahshan: None. T Dumont: None. P Kan: None. E Levy: Stent Assisted Recanalization in Acute Ischemic Stroke—SARIS, Boston Scientific, Codman & Shurtleff, ev3/Covidien Vascular Therapies. Scientific Advisors to Codman and Shurtleff, ev3/Covidien Vascular Therapies, TheraSyn Sensors Inc., Intratech Medical Ltd., Mynx/Access Closure. Fees for carotid stenting training from Abbott Vascular, Fees for carotid stenting training from ev3/Covidien Vascular Therapies. A Siddiqui: National Institutes of Health (co-investigator NINDS 1RO1NS064592-01A1 Hemodynamic Induction of pathologic remodeling leading to intracranial aneurysms, Research Development Award from University at Buffalo. Codman & Shurtleff, Inc, Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra. Genentech. Abbott Vascular, American Association of Neurological Surgeons courses.Abstract E-022 Figure 1