bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-019 Novel aneurysm neck reconstruction device: initial experience in an experimental pre-clinical bifurcation aneurysm model: Abstract E-019 Figure 1
Authors: Turk A , Tateshima S , Chaudry M , Fiorella D , Turner R , Kelly M 
Published: July 2012

IntroductionTreatment of wide necked bifurcation aneurysms often poses procedural and long-term outcome challenges. We describe the initial preclinical experience with the Pulsar Vascular Aneurysm Neck Reconstruction Device (PVANRD) in a canine bifurcation model.MethodsExperimental bifurcation vein pouch aneurysms were surgically created in the carotid arteries of eight canines. Endovascular coiling of the aneurysms with assistance of the PVANRD was performed in all cases with acute performance compared to Y-stenting.Results12 devices were deployed in the eight cases. Device deployment was straightforward and successfully protected the parent artery and maintained patency of the bifurcation in all cases, despite the use of oversized coils.ConclusionThe PVANRD is a novel bifurcation stent that facilitates treatment of wide necked bifurcation aneurysms compared with currently available adjunctive devices.Competing interestsA Turk: Pulsar Vascular. S Tateshima: None. M Chaudry: None. D Fiorella: None. R Turner: None. M Kelly: None.Abstract E-019 Figure 1
E-002 Acute endovascular therapy in young ischemic stroke patients and the role of intra-arterial vasodilator in the process of recanalization
Authors: Lodi Y , Elzammar Z , Cummins M , Devasenapathy A , Latorre G , Swrankar A 
Published: July 2012

IntroductionEndovascular therapy using IA tPA +/- Thrombectomy is an option for those who are either not a candidate or failed IV tPA. However, a little is known about age specific outcome. Our objectives are to describe the radiographic and clinical outcome of young patients (<65) who underwent acute stroke interventional therapy as well as evaluate the role of IA vasodilators in the process of recanalization.MethodsConsecutive patients underwent acute stroke intervention from 2007 to 2010 were enrolled. Patients demographic, presenting NIHSS, use of IA thrombolytic, vasodilator, and recanalization rate were recorded. Patients' outcome using Glasgow Outcome Scale Score was measured at 30 days.Results38 patients (mean age 38±14; median NIHSS 16) received intervention, 11 patients had failed IV tPA. Patients were offered therapy within 8 h except for five cases (stroke at awakening). IA tPA was given in 36, thrombectomy was done in 30, and 21 patients received IA vasodilator (16 Varapamil; 5 Nitroglycerine). Overall recanalization was near to complete in 92%. All patients received IA vasodilator have recanilized (TIMI III 13/21 and TIMI II 8/21).Overall 30-days outcomeGood was observed in 51% (GOS 5 in 11, GOS 4 in 7), Dependence (GOS 3) in 34%, and Death (GOS 1) in 14%; vasodilators' group showed similar outcome with Good in 42% (7/17), Dependence in 41% (7/17) and Death in 17% (3/17). Poor outcome was associated with high NIHSS and poor recanalization.ConclusionsAcute endovascular therapy achieves a high rate of recanalization in young acute ischemic stroke. IA vasodilators use during thrombectomy was associated with higher rate of recanalization. Further study is required to evaluate the role of vasodilators in acute stroke interventions.Competing interestsNone.
E-027 Stent graft repair of carotid pseudoaneurysm in a young child with short-term follow-up: Abstract E-027 Figure 1
Authors: Somers S , Basu S , Zouros A , Abou-Zamzam A , Jacobson P 
Published: July 2012

IntroductionTraumatic pseudoaneurysm of the carotid artery is a dangerous complication of penetrating trauma. Stent grafting is an accepted treatment; however the youngest reported patient so treated at the time was 11 years old. We report the successful use of stent grafting in the case of a 4-year-old female with carotid pseudoaneurysm from penetrating neck injury.Clinical Materials and MethodsAn otherwise healthy 4-year-old girl presented to an outside ED after accidentally stabbing herself in the neck with a toy fishing pole while using a slide. Physical examination demonstrated a small puncture wound to the right neck and no neurologic deficit. Initial CT examination demonstrated complete occlusion of the right internal carotid artery (RICA). After transfer to our institution, catheter angiography showed a patent RICA with focal 35% stenosis and double wall pseudoaneurysms at the level of C2. Vascular surgery and pediatric neurosurgical consultations indicated that surgical repair was not optimal due to the uncertainty of distal control and the likely need to disarticulate the right TMJ for exposure; stent grafting was requested and preferred to RICA sacrifice. After informed consent for possible off-label stent grafting vs RICA sacrifice, the patient was placed under general anesthesia. After access of both common femoral arteries and heparinization (800 units IV), an angiographic RICA balloon test occlusion showed probably adequate collateral supply to the right anterior circulation. DSA showed interval growth of the anterior and posterior wall RICA pseudoaneurysms and increased stenosis (50%). The decision was taken to stent graft the RICA. A 7F sheath was positioned in the RCCA and a Viabahn 5 mm × 25 mm self-expanding stent graft (Gore) was deployed across the lesion. A minor endoleak from the anterior pseudoaneurysm nearly resolved after balloon dilation of the stent. Hemostasis was obtained manually. Patient was loaded with aspirin and clopidogrel (16 mg) after the procedure for a 1-month course.ResultsThe patient was neurologically intact after the procedure with preservation of her right pedal pulses. Baseline postprocedure duplex and MRA showed wide patency of the stent graft without visible endoleak. Repeat duplex at 8 weeks redemonstrated wide patency of the graft and occlusion of the pseudoaneurysms. On a clinic visit at 10 weeks, the neurological examination was normal, no neck bruit was audible, and the right pedal pulses were 2+.ConclusionCarotid stent graft is a viable treatment option for traumatic pseudoaneurysm in children as young as 4 years of age.Competing interestsNone.Abstract E-027 Figure 1
E-034 Stent assistance in neurointerventional procedures
Authors: Buciuc R , Luzardo G 
Published: July 2012

IntroductionBalloon assistance for endovascular management of intracranial aneurysms is an established technique. There are possible limitations to this technique related to either anatomical or functional factors (patient intolerance to baloon occlusion). The authors present their experience using a retrievable intracranial stent as an assistive device for either coiling of aneurysms or navigation or microcatheters in difficult anatomy.MethodsA total of three patients underwent neurointerventions using a retrievable stent assistance technique. Two patients had intracranial aneurysms, one at the posterior communicating segment level and the other supraclinoid. An additional patient with a posterior circulation AVM underwent stent-assisted navigation of a microcatheter for Onix embolization of the malformation. In all cases the stent was partially deployed and used only to assist either in coil placement or in navigation of the microcatheter through a tortuous PICA. In one aneurysm case the carotid was anatomically isolated, therefore it has been percieved that temporary baloon occlusion might be exposing the patient to irreversible ischemia. In the other aneurysm case the intent was to withdraw the stent after assistance due to possible difficult post-op management of antiplatelet therapy. In the AVM case the stent was used after and attempt of using balloon assistance for navigation failed. None of the patients who underwent stent assistance, received antiplatelets in advance. Should the stent not have been retrieved, emergent antiplatelet therapy would have been initiated.ResultsIn all three cases the stent was retrieved successfully and contributed to effective management of the case. There were no complications related to the stent usage.ConclusionThe usage of stent assistance in neurointerventional cases has a potential use for situations in which balloon assistance is not possible or unsuccessful. A larger series of cases is however necessary to demonstrate safety and reproducibility of this techniqueCompeting interestsNone.
E-037 Midterm outcomes of endovascular treatment in unruptured superiorly projecting paraclinoid aneurysms
Authors: Matsumoto Y , Kondo R 
Published: July 2012

PurposeIn the treatment of superiorly projecting paraclinoid aneurysms (SPP ANs), coil embolization (CE) has been considered inferior to surgical clipping (SC) because of the high rates of recanalization and ischemic complication. However, innovation of endovascular technology could overcome such disadvantages. This study was designed to evaluate recent results of CE in SPP ANs.Materials and Methods43 consecutive patients with unruptured SPP ANs treated between 2004 and 2010 were retrospectively reviewed. SPP ANs include ophthalmic ANs and anterior wall ANs (AW ANs). Ophthalmic ANs arise at the junction of the ophthalmic artery and the internal carotid artery (ICA). AW ANs superiorly arise from the supraclinoid ICA without branching arteries. Midterm angiographic outcomes and complication rate were compared between CE and SC.Results33 patients underwent CE and 10 patients underwent SC. The CE group included 30 small ANs (<12 mm) and three large ANs (12–25 mm). The SC group included eight small ANs and two large ANs. In the CE group, recanalization was observed in two large ANs (6.1%) for a mean follow-up period of 27.2 months. Small ANs did not reveal recanalization. One of the recanalised ANs underwent a second CE and no recanalization was observed for 12 months after retreatment. The other received parent artery occlusion. In the SC group, no recanalization was observed during the follow-up period (mean: 32.9 months). Procedure-related morbidity was 2.9% (1/33) in the CE group and 10.0% (1/10) in the SC group.ConclusionCoil embolization for SPP ANs was equivalent to SC in terms of midterm durability and safety, particularly for small ANs.Competing interestsNone.
E-039 Impact of contrast load for acute ischemic stroke endovascular therapy on renal function
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 effect of contrast load given during endovascular revascularization on renal function in acute ischemic stroke (AIS) patients.ObjectiveThe aim of this study was to evaluate the effect of contrast load on the Creatinine (Cr) levels of AIS patients undergoing endovascular treatment.Design/methodsConsecutive AIS patients in Grady Memorial Hospital were retrospectively analyzed. The AIS transfers from outside hospitals were excluded from this study given uncertainty about prior contrast load and in some instances lack of documented Cr levels. Patients' demographic information, baseline NIHSS, site of occlusion, revascularization modalities were collected. The Cr, immediately before (PRE-Cr) and the highest Cr within 72 h after the endovascular procedure (POST-Cr) were recorded. Descriptive statistics are provided.ResultsForty-three patients (age 68±14; 44% male) with large vessel occlusions were included (25 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. Twenty-one percent of the patients were diabetics. Two of the patients had Cr >2.0 at baseline. Sixty percent of the patients had CT Angiography of the head/neck with contrast before the procedure. Patients had PRE and POST Cr of 1.2±0.4 (median: 1.1, IQR: 0.9–1.3) and 1.1±0.5 (median: 1.0, IQR: 0.75–1.2), respectively. None of the 41 patients with baseline Cr <2.0 had Cr elevation >2.0 and only one patient had Cr elevation >50% of baseline. None of two patients with baseline Cr >2.0 had Cr elevation >50% of baseline. None of the patients required dialysis.ConclusionsOur results suggest that endovascular management of acute stroke has minimal impact in kidney function in the first few days after the procedure.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 Medical.
E-043 Image guided sympathetic blocks
Authors: Massari F , Tsai N , Rumboldt Z , Pedicelli A , Bonaldi G , Cianfoni A 
Published: July 2012

Introduction/purposeAim of this education exhibit is to offer an overview on image guided sympathetic blocks, focusing on specific indications and techniques, through the use of Fluoroscopy and/or CT imaging guidance, at each level of blockade.Materials and MethodsSympathetic blocks are used for diagnostic, prognostic and therapeutic purposes for painful and other conditions associated with sympathetic system dysfunctions. Main indications for sympathetic blockade are: Complex regional pain syndrome (CRPS), phantom limb pain, central pain, hyperhydrosis, acute pancreatitis, and abdominal viscera cancer pain. Stellate ganglion blocks are utilized for painful and non-painful conditions related to sympathetic dysfunctions of head, neck and upper extremities. Thoracic sympathetic blocks are utilized for CRPS, postoperative analgesia, pain from fractured ribs, therapeutic control of hyperhydrosis of the upper limbs and torso, liver capsule pain after blunt trauma, acute postherpetic neuralgia, and premature ventricular contractions. Coeliac plexus blocks are utilized in pain due to intra-abdominal cancer, stemming from organs innervated by coeliac plexus. Lumbar sympathetic blocks are utilized for CPRS of the lower extremities, herpes zoster, amputation stump pain and inoperable peripheral vascular vasospastic diseases of the lower limb. Superior hypogastric blocks are utilized for pelvic pain, and pelvic organs cancer pain (uterus, cervix, bladder, prostate, urethra, testes and ovaries). Impar ganglion blocks are utilized in coccydynia.ResultsThe sympathetic nervous system has been implicated in numerous pain syndromes including neuropathic, vascular and visceral pain. In relation to this, in order to determine the sympathetic role in the transmission of pain and to manage these algic syndromes, sympathetic ganglia are targeted for local anesthetic blocks, for diagnostic, prognostic, and therapeutic purposes, balanced in a more complex pain treatment strategy, in the treatment of CRPS and other pain conditions. Safe and precise performance of these blocks requires knowledge of the loco-regional anatomy, accurate imaging guidance, and rigorous technique. Elements of relevant fluoroscopic and cross sectional anatomy, as well as procedural technique elements are discussed and displayed.ConclusionThis educational exhibit summarizes the indications, the anatomy and the techniques, under Fluoroscopy or CT guidance, for the sympathetic blocks.Competing interestsNone.
E-048 Flow characteristics of three toroidal aneurysms
Authors: Hui F , Piccinelli M , Passerini T , Spiotta A , Moskowitz S , Tong F , Veneziani A 
Published: July 2012

IntroductionDonut-shaped, or Toroidal aneurysms are a rare angiographic morphology wherein an intraluminal thrombus forms at the center of the aneurysm sac, creating a “hole” in the flow of blood. Formation of these “cross-bars” of clot is presumably related to flow characteristics related to the shape of the aneurysm sans-thrombus.MethodsIn these computational flow dynamics (CFD) investigations, assessment of the native flow characteristics was made, as well as CFD for the lesion with the axial thrombus mathematically removed from the model to assess probable flow characteristics.Findings and conclusionCFD findings show flow characteristics are displayed. And discussion of further directions of analysis will be given.Competing interestsNone.Abstract E-048 Figure 1Abstract E-048 Figure 2
E-051 Putting the “Eye” in I.V. Access—unconventional approaches in head and neck intervention
Authors: Baxter B , Mayich M , Hungerford J 
Published: July 2012

Introduction/purposeUnconventional Access techniques have been documented in the literature and have the potential to provide a complimentary platform for intervention in select cases. This limited case series illustrates two such approaches.Materials/methodsPeriprocedural clinical data and imaging was gathered around two cases requiring unconventional methods of access.ResultsA 29-year-old female with known NF-1 was found to have a large dural AVF causing significant compression of the cervical cord. In the first stage of embolization, the right vertebral artery and thyrocervical perforating vessels providing antegrade flow to the lesion were occluded using a traditional femoral approach. Access to the left vertebral artery from the same approach was precluded by an aplastic proximal segment. Access to deploy coils and onyx to the distal right vertebral artery occluding retrograde filling was achieved by direct puncture of the artery near the skull base under fluoroscopic guidance. A 67-year-old female was diagnosed with a dural cavernous-carotid fistula after presenting with proptosis and conjuctival chemosis. Embolization of perforating branches from the external carotid by femoral approach was unsuccessful in occluding flow. Access was obtained by performing a limited cut down of the upper eyelid with ultrasound-guided catheterization the superior ophthalmic vein. Embolization of the cavernous sinus with coils and onyx resulted in immediate symptom resolution.ConclusionIn the absence of favorable access to a lesion by conventional femoral approach, unconventional access techniques may be safely employed for definitive treatment.Competing interestsB Baxter: Stryker Neurovascular, Penumbra, EV3, Codman, Rapid Medical, Reverse Medical. M Mayich: None. J Hungerford: None.
E-053 Activated clotting time measurements are essential for monitoring effective anti-coagulation during endovascular neurosurgical procedures requiring the use of heparin
Authors: Hou S , Gounis M , Wakhloo A 
Published: July 2012

Background and PurposeSafe and effective anticoagulation plays a pivotal role in neuro-interventional procedures. Patients routinely receive heparin for prevention of intra-procedural thrombosis or thromboembolic complications. We have recently noticed time-dependent variations in intra-procedural thrombosis and thromboembolic complications during our neuro-interventional procedures. Here, we evaluate the effectiveness of our intra-procedural anticoagulation therapy.Materials and MethodsWe performed a retrospective case review, comparing the total amount of intravenous heparin administered per case, the peak activated clotting time (ACT) as measured by the i-STAT system, and number of intra-procedural thrombotic complications of 27 consecutive intracranial endovascular neurosurgical procedures requiring intra-procedural anticoagulation from July 1, 2011 through October 15, 2011 (Group 2011) compared to 40 consecutive intracranial endovascular neurosurgical procedures requiring intra-procedural anticoagulation from July 1, 2010 through December 31, 2010 (Group 2010).ResultsThe mean for total heparin dose given per case for Group 2011 was 12 903 units of heparin, with a SD of 6901, while the mean for total heparin dose given per case for Group 2010 was 8463 units of heparin with a SD of 2484 (p<0.0001, t-test). The peak ACT per case for Group 2011 was 299.2 s with SD of 47.02 compared to the peak ACT per case for Group 2011 was 315.7 with SD of 39.62 (ns). There were a total of six thrombotic complications for Group 2011 vs one thrombotic complication for Group 2011 (p<0.05, Fisher Exact Test). The RR of experiencing a thrombotic complication between the two groups (2010 vs 2011) is 4.266 (95% CI 0.6873 to 26.475).Discussion and ConclusionsWhen comparing Group 2011 with Group 2010, it took significantly more heparin to maintain similar peak ACT levels and there was a significant increase in the risk of developing a thrombotic complication. These findings are highly suggestive of the decreased effectiveness of intravenous heparin during the dates of July 1, 2011 through October 15, 2011 when compared to a similarly matched group of patients receiving heparin between July 1, 2010 through December 31, 2010. The total heparin dose per case for Group 2011 was not titrated to a predetermined ACT value prior to the start of the endovascular neuro-intervention, but rather a cumulative sum dose of heparin after the end of the procedure. These data give evidence that obtaining an adequate ACT level prior to the start of any endovascular neuro-interventional procedure requiring the use of heparin.Competing interestsNone.
E-056 Time from CT to groin puncture lower in patients transferred from outside hospitals compared to the local emergency room
Authors: Nogueira R , Glenn B , Belagaje S , Anderson A , Frankel M , Nahab F , Gupta R 
Published: July 2012

IntroductionPatients being transferred from outside facilities are often excluded from intra-arterial therapy due to delays in transfer, evaluation and imaging. The Marcus Stroke and Neuroscience Center at Grady Memorial Hospital is a unique prototype for stroke reperfusion therapies in the future. The CT scanner and biplane angiography suite are housed in the intensive care unit. Patients being transferred from outside facilities are brought directly to the intensive care unit where imaging and reperfusion therapies can be performed rapidly. We sought to determine if there were time differences in patients evaluated in our emergency room compared to transfers from outside facilities.Materials and MethodsA prospective database of consecutive intra-arterial therapy at the Marcus Stroke Center was reviewed. Patients treated from October 2010–January 2012 were reviewed. We assessed demographic, radiographic and clinical variables in addition to if patients were transferred from outside facilities. We assessed times from CT to groin puncture for patients evaluated in our emergency room and compared them to patients transferred from outside hospitals. Patients with anterior circulation strokes <8 h from symptom onset were assessed. Patients with posterior circulation strokes were excluded. We performed Fisher's exact testing for categorical variables and student's t-test for continuous variables.ResultsA total of 165 patients with a mean age of 66±13 years with a mean NIHSS of 19±5. A total of 109 (65%) patients were transferred from outside hospitals. Patients from outside facilities were significantly less likely to have hypertension (61% vs 81%, p<0.01) but there were no baseline differences in age, NIHSS, clot location and time from symptom onset. Patients transferred from outside facilities had significantly lower times from CT at our institution to groin puncture compared to patients from our emergency room (42±20 min vs 74±30 min, p<0.0001).ConclusionsThe presence of a biplane angiography suite in the neurological intensive care unit may help to reduce times to reperfusion in patients being transferred from an outside facility. Developing systems of care to reduce times to reperfusion will require assessment of systems of care that focus on available resources. Efficient systems to treat patients from outside hospitals may help to improve the ability to offer treatments to more patients.Competing interestsR Nogueira: EV3, Rapid Medical, Concentric, CoAxia. B Glenn: None. S Belagaje: None. A Anderson: None. M Frankel: None. F Nahab: None. R Gupta: Concentric Medical, CoAxia, Rapid Medical, Codman Corp.