bluuebunny/crossref_metadata_2025_split huggingface dataset:
O-003 Prediction of periprocedual ischemic complication in carotid artery stenting with filter embolic protection device: feasibility of MR plaque imaging
Authors: Takayama K , Nakagawa H , Taoka T , Miyouchin K , Wada T , Sakamoto M , Miyasaka T , Akashi T , Kichikawa K , Kurokawa S 
Published: December 2010

PurposeOur purpose is to investigate the feasibility of MR plaque imaging to predict the high risk lesion for ischemic complication during carotid artery stenting (CAS) using a filter embolic protection device (EPD).Methods100 carotid artery stenotic lesions in 96 patients before CAS (89 men and seven women; median age 72.2 years) were evaluated by MR plaque imaging with black blood T1 weighted images. The population consisted of 52% symptomatic stenosis, more than 50% at the common or internal carotid artery, and 48% asymptomatic stenosis more than 80% stenosis. All CAS procedures were performed by standard procedure using filter EPD (Angioguard XP). Main plaque components were classified into unstable plaque (intraplaque hemorrhage and lipid rich/necrotic core) and stable (fibrous tissue and dense calcification) from the signal pattern. Development of new ischemic lesions on diffusion weighted imaging was assessed within 48 h after CAS. We made statistical assessment on the plaque classification and the number of new ischemic lesions.ResultsTechnical success with the CAS procedures was achieved in 100 (100%) procedures. Ipsilateral new ischemic lesions were observed in 34 CAS procedures (34.0%). Ipsilateral multiple ischemic lesions (>10) were observed in seven CAS procedures (7%). In seven patients with multiple ischemic lesions, four showed minor strokes, two showed a transient ischemic attack and one was asymtopmatic. New ischemic lesions except multiple ischemic lesions were all asymtopmatic. There was no significant difference between unstable and stable plaques for the presence of new ischemic lesion. However, multiple ischemic lesions occurred significantly (p<0.01) more frequently in patients with unstable plaque.ConclusionsPresence of unstable carotid plaques showed a higher risk of ischemic complication of CAS with filter EPD than stable plaques.
O-031 Hyperacute cortical neuroplasticity following preoperative embolization of brain AVMs
Authors: Eesa M , Festa J , Lazar R , Meyers P 
Published: December 2010

PurposeCerebral arteriovenous malformations (AVM) occur due to abnormal vascular morphogenesis, and reorganization of neurological function has been well documented in patients harboring them. Patients undergoing endovascular treatment for nidal reduction of brain AVMs prior to surgical resection may develop transitory neurological symptoms which may represent a manifestation of such a response occurring in a hyperacute fashion. The purpose of this study was to demonstrate any functional MRI (fMRI) evidence for hyperacute neuroplasticity in patients with brain AVMs undergoing pre-operative embolization.Materials and methods12 patients (aged 24–55 years; mean 38±7.6 years; nine men, 10 right-handed) with cerebral AVMs who underwent preoperative embolization at our center from 2004 to 2008 and elected to participate were included in the study. All patients had baseline MRI studies performed on 1.5 or 3 T GE Magnet which included blood oxygen level dependant (BOLD) fMRI studies using multiple motor, visual and language paradigm(s). Patients were pretreated with anticonvulsants and maintained therapeutic levels. Patients then underwent diagnostic catheter angiograms, superselective arteriography and provocative testing (WADA) prior to the embolization in the same procedure. Patients were then taken for repeat fMRI studies within 1–2 h. Pre and post-embolization fMRI data were evaluated by readers who were blinded to the patient data. The BOLD fMRI data was coregistered onto the structural images and categorized as no reorganization or definite reorganization of neurological function.ResultsA total of 12 eloquent region AVMs were treated in 12 patients. There were two grade II and 10 grade III AVMs. All patients underwent an embolization procedure as per the institutional protocol with the aim of nidal penetration and maximal nidal reduction using n-butyl cyanoacrylate (Trufil NBCA: Cordis Neurovascular, Raynam, Massachusetts, USA). There were no major (stroke or death) or minor complications. One patient developed a transient neurological deficit (aphasia) immediately following endovascular treatment and was shown to have relocated language function without diffusion weighted infarction. There were no hemorrhagic complications.ConclusionsHyperacute neuroplasticity may be demonstrated in patients with cerebral AVMs undergoing preoperative embolization and occlusion. This may explain some of the transient neurological deficits that are not uncommonly seen in such patients. Improved characterization of this neuroplastic response may be useful in the treatment planning of AVM patients and rehabilitative care of acute stroke patients.Abstract O-031 Figure 1
O-008 Long term angiographic follow-up of intracranial dural arteriovenous fistulas treated with Onyx embolization: consecutive series of 37 patients
Authors: Nogueira R , Rabinov J , Dabus G , Yoo A , Ogilvy C , Hirsch J , Pryor J 
Published: December 2010

BackgroundOnyx is a non-adhesive liquid embolic agent that has gained wide acceptance in the treatment of intracranial pial AVMs. However, only a few series have addressed the results of Onyx embolization for the treatment of dural arteriovenous fistulas (DAVFs). We now report on the long term results of Onyx treatment for intracranial DAVFs.MethodsWe performed a retrospective analysis of 37 consecutive patients with intracranial DAVFs (a total of 39 lesions) who were treated with Onyx as the single treatment modality between March 2006 and April 2009. A trans-arterial approach was employed in all cases, and Onyx-18 or a combination of Onyx-18/Onyx-34 was used to embolize the DAVF. Patients underwent control angiography at 3 months and 12 months post-embolization to assess for recurrent or residual shunting.ResultsMean age of these 37 patients was 56±11 years (median 56, range 30–76). There were 22 men and 15 women. 11 lesions (29.7%) were classified as Cognard IV/Borden 3; 14 lesions (37.8%) as Cognard III/Borden 3; four lesions (10.8%) as Cognard IIa + IIb/Borden 2; three lesions (8.1%) as Cognard IIb/Borden 2; one lesion (2.7%) as Cognard IIa/Borden 1; and four lesions (10.8%) as Cognard I/Borden 1. A total of 46 procedures were performed (three procedures in three patients; two in three patients; and one in 31 patients). Complete angiographic cure on immediate post-treatment angiography was achieved in 35 patients. One patient underwent surgical resection after partial embolization. The remaining patient had a residual fistula involving the jugular fossa below the skull base without evidence of any residual intracranial component. Complications included one asymptomatic extracranial vertebral artery dissection and two facial palsies. There was no other significant morbidity or mortality. Follow-up angiography is currently available in 34 patients. There was no evidence of residual or recurrent DAVF in 33 patients. One of the initially “cured” patients had evidence of a small recurrent DAVF on short-term follow-up. This was attributed to lack of penetration of the embolic agent into the proximal venous compartment. This patient was asymptomatic and was subsequently embolized with Onyx resulting in stable cure on follow-up angiogram performed 11 months later. Twenty-one patients have long term (>1 year) follow-up; 19 of these had follow-up angiography at both 3 and 12 months. In all these 19 cases, the angiographic results were stable across the two time epochs.ConclusionIn our experience, the endovascular treatment of intracranial DAVFs with Onyx is safe and highly effective with no evidence of any significant recurrence in the long term follow-up. A single angiography at 3–6 months appears to be reasonable in the follow-up of these patients.
E-015 Onyx embolization of facial arteriovenous malformations
Authors: Chaudry I , Turner R , Turk A 
Published: December 2010

IntroductionVascular malformations of the head and neck encompass a wide range of lesions, including lymphatic malformations, hemangiomas, venous malformations and true arteriovenous malformations. Treatment of these lesions is challenging because of the vital structures in the region as well as the need to preserve function and aesthetics. The mainstay of treatment has been reconstructive surgery and glue embolization. Onyx is an ideal embolization material; however, its use has been limited due to concerns of tattooing the skin. We present three cases of high flow facial arteriovenous malformations effectively embolized transarterially and/or percutaneously with Onyx without complication.Case presentationPatient No 1 is a 22-year-old man with arteriovenous malformation of the right lower lip with a high flow fistulous component. The patient presented because of prominence of the lower lip and daily episodes of pulsatile bleeding from the lip. Patient No 2 is 16-year-old woman with a left malar arteriovenous malformation (AVM) who presented because of asymmetric prominence of her left cheek that was intermittently painful and occasional episode of epistaxis. Patient No 3 is an 11-year-old girl with a large left maxillary AVM who presented with multiple episodes of epistaxis, bleeding from her mouth after brushing her teeth and emesis consisting of swallowed blood.ResultsThe three patients were successfully embolized utilizing either a transarterial or percutaneous approach with Onyx. Specifically, patient No 1 had embolization of the facial artery and lower lip AVM in two stages. There was some tattooing of the lower lip which was acceptable as it was within the planned resection field. There were no other areas of tattooing along the remainder of the lip, lateral commisure or chin. Patient No 2 had transarterial embolization of the descending palatine artery and sphenopalatine arteries with cure. No tattooing of the left check or nasolabial fold was seen. She has persistent hypertrophy of the left cheek soft tissues and is planned for reconstructive molding of the cheek. Patient No 3 had embolization of the sphenopalatine artery, descending palatine artery and facial artery as well as direct percutaneous embolization of her maxillary AVM. No tattooing of her cheek, lips, oral mucosa or gums were noted.ConclusionTransarterial and percutaneous embolization of facial AVMs can be safely performed with little risk of tattooing the skin or mucosal surfaces.
E-016 Enterprise stent assisted coil embolization of cerebral aneurysms
Authors: Afshani M , Hoit D , Morris S , Barr J , Arthur A 
Published: December 2010

IntroductionCerebral aneurysms have morphometric features that influence the initial and long term success of coil embolization. Advances in coil assist technology now permit endovascular treatment of previously uncoilable aneurysms. We report a single institution experience of 52 patients with intracranial aneurysms that necessitated stent adjunctive treatment for occlusion, with angiographic follow-up studies available on 46 of the 52 patients.MethodsBetween May 2007 and November 2009, 52 patients with 55 intracranial aneurysms were treated by Enterprise stent mediated coil embolization. Initial and short term demographic, clinical and radiographic outcome data were collected and analyzed for technical success of the initial intervention, clinical complication rates, 6 month occlusion and recannalization rates, and delayed radiographic complications.ResultsSeven aneurysms in seven patients were re-treatments of previously coiled aneurysms. 48 aneurysms in 45 patients were stent coiled as an initial treatment. 13 were treated after an acute subarachnoid hemorrhage. Initial procedural results showed complete occlusion (Raymond I) in 14/55 (25%), neck remnant (Raymond II) in 12/55 (22%) and incomplete occlusion (Raymond III) in 29/55(53%). Periprocedural complications were infrequent, with no aneurysm perforations, and one thromboembolic event resulting in an anterior cerebral artery stroke. Stent migration was the most frequent technical complication occurring in four cases. Six month follow-up arteriography was available for 46 patients with 48 aneurysms. Complete occlusion was present in 28/48 (58%) aneurysms, neck remnant or regrowth was present in 12/48 (25%) and 8/48 (17%) were incompletely treated. Five patients with five aneurysms eventually underwent further embolization, and delayed placement of a second enterprise stent was necessary in one patient. In-stent stenosis was an infrequent problem occurring in 4/48 (8%), none of which were hemodynamically significant. One patient developed a mild stenosis in a perforating vessel adjacent to the stent.ConclusionThe Enterprise stent is a safe and useful device in treating wide necked cerebral aneurysms. Our short term experience demonstrates a low rate of complications and a trend toward progressive occlusion among patients who initially had a neck or dome remnant.
E-017 Emergency Onyx embolization of avulsed basilar artery perforator following an endoscopic colloid cyst resection
Authors: Turner R , Lena J , Chaudry I , Turk A 
Published: December 2010

IntroductionEndoscopic resection of a colloid cyst and third ventriculostomy is a well described neurosurgical procedure and is performed commonly. Inadvertent vascular injury can occur due to the limited peripheral field of view offered by the endoscope. We present a case of colloid cyst resection and third ventriculostomy where neurological decline occurred during anesthesia emergence and imaging demonstrated active basilar perforator extravasation on CT angiography (CTA) which was treated with emergency embolization.Case presentationA 23-year-old man presented with headaches. He was found to have hydrocephalus due to a third ventricular colloid cyst. The patient underwent endoscopic resection and third ventriculostomy. During emergence, the patient was found to have a dilated right pupil. A ventriculostomy drain was placed and the patient underwent emergent CT/CTA which demonstrated intraventricular and pre-pontine hemorrhage with active extravasation. The patient underwent emergency angiography which demonstrated active contrast extravasation from a right P1 thalamoperforator. The vessel was catheterized and embolized with Onyx (eV3, Plymouth, Minnesota, USA) (Abstract E-017 figure 1).Abstract E-017 Figure 1ResultsThere was immediate cessation of extravasation. The patient recovered and was following commands and getting out of bed. He had a complicated clinical course and subsequently developed meningitis and infarcts of his right middle cerebral artery territory and left basal ganglia from vasospasm. His prolonged hospital course concluded and the patient was discharged to home.ConclusionVascular injury is a rare but devastating complication of intracranial surgery. This is a unique case where emergent endovascular surgery immediately yielded an optimal angiographic result and provided the patient the best opportunity for recovery.
E-031 070 Neuron conduit technique for intracranial delivery and deployment of 6 mm and 8 mm carotid stents in the setting of proximal vessel tortuosity
Authors: Turner R , Chaudry I , Turk A 
Published: December 2010

IntroductionEndovascular stenting is a common treatment modality for intravascular stenosis. Current intracranial devices are relatively atraumatic and flexible to allow for navigation through tortuous anatomy such as the carotid siphon to reach its intended target. At times, large vessel diameters preclude the use of intracranial stents. Larger carotid or wall stents are limited in their ability to navigate tortuous anatomy due to their stiffness. We present two cases where vessel size demanded a larger stent but vascular tortuosity prevented primary navigation to the target lesion.Case presentationThe first patient was found to have symptomatic sagittal sinus stenosis with venous outflow obstruction due to compression from a posterior interhemispheric fissure meningioma. She presented with blurred vision and papilledema. The second patient had symptomatic right internal carotid stenosis and stroke symptoms.ResultsIn both cases, severe tortuosity was present proximal to the target location. In each case, a 070 Neuron (Alameda, California, USA) was able to navigate through the tortuosity and across the intended lesions. In the first patient, a 8 mm×40 mm Cordis Precise (Miami Lakes, Florida, USA) stent tracked through the Neuron, which was then withdrawn and the stent was successfully deployed in the superior sagittal sinus. The patient had the second stent placed using the same technique from the torcula to the right transverse sinus. In the other patient, attempts to primarily navigate through the tortuous carotid artery to reach the target location failed. The 070 Neuron was able to safely and successfully navigate through the tortuosity over an 038 glide wire and cross the target lesion. Two Cordis Precise stents (6 mm×20 mm and 5 mm×20 mm) were able to successfully navigate through the Neuron and deploy across the lesion in the internal carotid artery petrous segment. Control angiography did not demonstrate any evidence of vascular injury or stroke.ConclusionSevere tortuosity can preclude successful primary navigation of larger, non-intracranial stents due to stent inflexibility. Use of a flexible guide catheter can provide a conduit to deliver these devices to their intended targets successfully.
E-032 Arteriovenous malformation management via endovascular embolization: Onyx versus n-butyl cyanoacrylate
Authors: El-Gengaihy A , Dawood A , Cornett O , Prestigiacomo C , Gandhi C 
Published: December 2010

IntroductionTreatment of brain arteriovenous malformations (BAVMs) is achieved by embolization, surgery, radiosurgery or any combination of these modalities. The aim of endovascular management of BAVMs before surgical resection is to minimize intraoperative blood loss, to occlude the entire BAVM or at least minimize the size of the nidus. Endovascular treatment is achieved by using n-butyl cyanoacrylate (n-BCA) or Onyx embolic agent.Methods14 Onyx and 15 n-BCA cases who were treated via endovascular procedures were randomly selected from 2003 to 2009 and were retrospectively analyzed. We began by comparing patient demographics, complication rates, Spetzler–Martin grading scale, BAVM volumes, pre- and post-embolization volumes, contrast loads, radiation times, as well as the number of feeder arteries. Volume of the nidus was calculated after three angiographic diameters of the lesion were obtained. The horizontal and vertical diameters were obtained from the anteroposterior projection and the longitudinal diameter from the lateral projection. We considered the BAVM to take an ellipsoid shape and we used Pasqualin method in calculating the volume of the BAVM:V= (wxhxl)/2ResultsThe mean pre-embolization nidal volume for Onyx and n-BCA cases were 5.59±4.84 cm3and 4.11±4.30 cm3, respectively. No significant statistical difference between Onyx and n-BCA pre-embolization volumes was observed. The mean post-embolization volume for Onyx and n-BCA were 2.68±2.72 cm3and 1.68±1.38 cm3, respectively. The per cent of obliteration of the BAVM was observed to be 71% in Onyx cases compared with n-BCA cases, which was 62.5% (p=0.2). Contrast load was observed to be higher in n-BCA cases compared with Onyx cases (p=0.8). However, fluoroscopy time was observed to be significantly higher in Onyx cases compared with n-BCA cases (P=0.0009). On the other hand, patients treated with Onyx as the sole embolic agent had fewer staged embolizations compared with n-BCA patients.ConclusionThe purpose of our study is to report our experience in using Onyx versus n-BCA and report our anatomic and clinical results accomplished using these two forms of treatment. Both modalities of treatment are comparable with regard to percentage of obliteration of the BAVM. However, Onyx requires a fewer number of staged embolizations to achieve the same degree of obliteration as one would achieve with n-BCA.
E-033 Percutaneous cement augmentation for treatment of metastatic lesions of the spine and pelvis using a novel highly viscous cement: experience in 17 consecutive patients
Authors: Georgy B 
Published: December 2010

PurposePercutaneous cement augmentation had been described for the treatment of the painful metastatic lesions of the spine and pelvic bones using standard vertebroplasty systems, usually with low viscosity cements, and has been associated with a higher percentage of leaks compared with benign fractures. The study was done to assess the safety, feasibility and clinical outcome of using a highly viscous cement injected using a hydrolic based device in the treatment of metastatic lesions of the spine and pelvis using fluoroscopy and CT guidance.Material and methodA series of 17 consecutively treated patients with different types of different primary and secondary tumors were identified for the review. There were a total of 29 lesions treated. Levels treated ranged from C7 to L5, sacrum, ilium and ischium. The degree of leakage was assessed at each treated level using a strict 4 point scale (none, minimal, moderate, severe). The pattern of any observed leakage was also characterized as: discal, venous, paravetebral, epidural or SI joint. Cement leaks were assessed using both plain films and CT. Visual analog score (VAS) for pain was collected before the procedure and within 2–4 weeks after.ResultsOn plain film there was no leak at 13, minimal at 9 and moderate at 2 levels. On CT there was no leak in 4, minimal at 15 and moderate at 2 levels. CT imaging identified 10 additional minimal leaks but did not identify any additional moderate or severe leaks.VAS pain data were available pre and post-procedure for 10/17 patients. Mean VAS pain score improved 49% from a mean preoperative score of 8.2 to a mean postoperative VAS of 4.2.ConclusionsPercutaneous cement augmentation of metastatic lesions of the spine and pelvis is feasible and safe using a high viscosity cement system. A hydrolic injection device allows more control over the injected cement into a small caliber needles. Cement augmentation results in pain relief, as measured by VAS, with a 49% decrease in pain score.
E-034 Endovascular internal trapping for ruptured dissecting vertebral artery aneurysms
Authors: Yamamoto D , Uemura A , Fujii M , Matsukawa H , Kobayashi N , Numaguchi Y , Murakata A , Shinoda M , Ishikawa R 
Published: December 2010

PurposeRuptured dissecting vertebral artery aneurysms should be treated immediately because of the high risk of rebleeding.The purpose of this retrospective study is to evaluate the efficacy of endovascular internal trapping by platinum coils for ruptured dissecting vertebral artery aneurysms.Materials and methodsWe retrospectively reviewed 13 cases (eight men and five women; aged 50–80 years; mean 65 years) of acutely ruptured aneurysms of the vertebral artery treated by endovascular internal trapping between April 2003 and February 2010. Endovascular trapping was done by coil embolization of the dissected arterial segment, including the aneurysm. Evaluated subjects included success of the therapy, presence of rebleeding, procedural complication and other technical issues.ResultsIn all cases, endovascular internal trapping was done successfully. There was no case of rebleeding. Three cases in which perforating arteries to brainstem originated from the dissected segment had postprocedural medullary infarction. However, the neurological symptoms diminished during the follow-up period.ConclusionEndovascular internal trapping is an effective and feasible therapy for ruptured dissecting aneurysms of the vertebral artery in terms of prevention of rebleeding. However, there is a risk of postprocedural medullary infarction in cases of perforating arteries originating from the dissected segment.