bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-020 The transcirculation treatment of cerebral aneurysms
Authors: Albuquerque F , McDougall C 
Published: December 2010

IntroductionUnfavorable anatomy can preclude embolization of intracranial aneurysms. Transcirculation techniques, in which a catheter is navigated from one side of the brain to the other or from the anterior to the posterior circulation, are alternative pathways for primary or balloon/stent assisted coiling. We report the largest experience in coil embolization of aneurysms using these techniques.MethodsWe prospectively reviewed our collected database from 2006 to 2009 and identified 20 patients who had aneurysms treated with transcirculation techniques.ResultsEight patients had anterior and 12 had posterior circulation aneurysms. Overall, nine patients required stent assisted coiling and 10 required balloon assisted coiling, including two patients treated with a ‘kissing balloon’ technique. Of the 10 patients, two requiring balloon assistance were also treated with stenting at the conclusion of aneurysm coiling. One patient with a left V4 aneurysm was treated with a bilateral vertebral artery (VA) approach. In 14 patients, the anterior communicating and posterior communicating arteries were used as conduits. In six patients, both VA were traversed to treat two V4 aneurysms, two posterior inferior cerebellar artery aneurysms, one basilar apex aneurysm and one basilar trunk aneurysm. Overall, two (10%) permanent complications occurred as a result of treatment: one death and one minor stroke. Complete or near complete (>95%) embolization was achieved in all patients.ConclusionsTrancirculation techniques are effective pathways for embolization of complex aneurysms. Although technically challenging, these techniques are associated with an acceptably low rate of complications when compared with the natural history of the treated lesion.Abstract P-020 Figure 1
P-021 Endovascular treatment of wide necked intracranial aneurysms using microcatheter protective technique: techniques and outcomes in 71 aneurysms
Authors: Lee J , Cho Y , Kwon B , Han M 
Published: December 2010

IntroductionCatheter protective technique, an adjunctive technique of multiple microcatheter techniques, means positioning an additional microcatheter, instead of a balloon or stent, in the parent or side branching arteries to protect them during coil embolization. The purpose of this study was to describe a microcatheter protective technique and to evaluate the radiologic and clinical outcomes.Materials and methodsFrom January 2003 to January 2010, 330 patients harboring 336 wide neck aneurysms were treated with detachable coils using multiple microcatheter techniques. 71 (21.1%) of 336 aneurysms were treated with a catheter protective technique. The aneurysms were in the following locations: middle cerebral artery (22, 31%), anterior communicating/anterior cerebral arteries (17, 23.9%), basilar artery bifurcation (13, 18.3%), posterior communicating artery (nine, 12.7%), anterior choroidal artery (four, 5.6%), internal carotid artery bifurcation (three, 4.2%), vertebral/posterior inferior cerebellar arteries (two, 2.8%) and posterior cerebral artery (one, 1.4%). Ten (14.1%) aneurysms were presented with subarachnoid hemorrhage and 61 (85.9%) were unruptured. The mean aneurysm neck size was 3.9±1.7 mm (range 1.9–13.8 mm) and the mean dome to neck ratio was 1.1±0.3 (range 0.7–2.8). Imaging follow-up, including plan radiography, magnetic resonance angiography or digital subtraction angiography, ranging from 3 to 36 months, was available in 57 (80.3%) patients, with a mean of 14.7±8.8 months. Immediate postprocedural completion angiograms were evaluated using a conventional angiographic scale. Clinical evaluations were performed using a Glasgow outcome scale.ResultsImmediate postprocedural angiograms demonstrated total occlusion of the aneurysm in 42 (59.2%) aneurysms, neck remnant in 16 (22.5%) and body filling in 13 (18.3%). There were 11 (15.5%) thromboembolic events that were treated with intra-arterial infusion of tirofiban. One (9%) of these 11 patients had a permanent neurologic deficit (sensory dysphasia). There was no significant difference in the rate of thromboembolic events between the parent artery protecting and side branching artery protecting groups (11.1% vs 17.6%; p=0.71). One patient died and the other patient was severely disabled from complications which were not related to the procedure, secondary to subarachnoid hemorrhage. All patients, except three complicated cases mentioned above, showed excellent clinical outcomes. Of the 57 aneurysms with follow-up, recanalization was developed in five (8.8%) aneurysms, and three (5.3%) cases of major recanalization were retreated endovascularly.ConclusionThe microcatheter protective technique is feasible and safe for coil embolization of wide neck aneurysms, especially in cases which are not suitable for the multiple catheter technique, balloon remodeling technique or stent assisted technique.
O-010 Effective minimally invasive treatment of moderate lumbar spinal stenosis with the superion interspinous spacer
Authors: Rappard G , Block J , Miller L , Chiu J , Bini W 
Published: December 2010

Introduction and purposeMild lumbar spinal stenosis (LSS) is treated with conservative measures although long term success remains elusive. Patients with severe radicular symptoms often require surgical intervention. However, there is a significant therapeutic void for patients with moderate LSS. The purpose of this study was to evaluate the preliminary effectiveness and safety of the Superion Interspinous Spacer (Vertiflex, Inc, San Clemente, California, USA) in patients with moderate LSS.Materials and methodsThis prospective study enrolled 121 patients (aged 58±14 years) with moderate LSS who were treated at EMMA Klinik (Seligenstadt, Germany) between February 2008 and August 2009 and followed-up at 1 (n=111), 3 (n=96), 6 (n=81) and 12 (n=52) months. Patients were treated with the Superion Interspinous Spacer, a minimally invasive spinal implant that limits back extension at the symptomatic level. Study outcomes included back function with Oswestry Disability Index, axial and extremity pain severity with a visual analog scale, health related quality of life with Physical Component Summary (PCS) and Mental Component Summary (MCS) scores from the SF-36, and adverse events.ResultsBack function rapidly improved from pretreatment (60.2±7.9%) to 1 month (33.6±10.3%) with continued improvement through to 12 months (21.0±13.7%), a 64% overall improvement (p<0.001) (Abstract O-010 figure 1A). Back function clinical success, defined as improvement of 30% or more from pretreatment values, was 92% at 12 months. Axial pain decreased at the 1 month visit (6.9±1.1 to 3.9±1.2) and this improvement was maintained through to 12 months (3.4±1.5), representing a 49% improvement (p<0.001). Similar improvements (53% overall, p<0.001) in extremity pain were observed (pretreatment: 6.6±1.4, 1 month: 3.3±1.4, 12 months: 2.8±1.5) (Abstract O-010 figure 1A). Clinical success at 12 months using a 30% improvement criterion was 76% for axial pain and 86% for extremity pain. Health related quality of life improved 41% for PCS (26.9±4.5 at pretreatment to 39.2±6.1 at 12 months) and 22% for MCS (36.0±4.2 at pretreatment to 44.0±5.7 at 12 months) (both p<0.001) (Abstract O-010 figure 1B). PCS clinical success (≥5.7 point improvement) was 81% and MCS clinical success (≥6.3 point improvement) was 62% at 12 months. Four (3.3%) explants were performed although three were unrelated to the device. Eight procedure related adverse events, observed in six (5.0%) patients, included superficial incision seroma (n=5), minor wound pain (n=2) and infection (n=1).Abstract O-010 Figure 1ConclusionThe Superion Interspinous Spacer is an effective and safe treatment option for patients with moderate LSS who are unresponsive to conservative care.
O-015 CLARITY Study: comparison of clinical results in GDC and matrix groups
Authors: Cognard C 
Published: December 2010

PurposeTo evaluate the clinical results of the endovascular treatment of ruptured intracranial aneurysms using GDC and matrix coils.Materials and methodsA prospective, multicenter registry was conducted in France from October 2006 to June 2007 in 19 neurointerventional centers to compare the endovascular treatment of ruptured aneurysms with GDC and matrix coils. 405 patients were treated with GDC coils and 377 with matrix coils.ResultsEndovascular treatment failed in 3/405 cases (0.7%) in the GDC group and in 2/377 cases (0.5%) in the matrix group. Adverse events related to the treatment were encountered in 71/405 patients (17.5%) in the GDC group and in 68/377 patients (18.0%) in the matrix group. Thromboembolic events were encountered in 54/405 patients (13.3%) in the GDC group and in 45/377 patients (11.9%) in the matrix group, intraoperative rupture in 15/405 patients (3.7%) in the GDC group and in 19/377 patients (5.0%) in the matrix group and early rebleeding in 2/405 patients (0.5%) in the GDC group and in 4/377 (1.1%) in the matrix group. Finally, morbidity and mortality to the treatment were, respectively, 4.0% (16/405) and 1.5% (6/405) in the GDC group and 4.0% (15/377) and 1.3% (5/377) in the matrix group.ConclusionThe CLARITY study demonstrates that the immediate safety of the endovascular treatment of ruptured intracranial aneurysms using GDC and Matrix coils is similar with low morbidity and mortality with both types of coils.
O-016 Immediate anatomical results after the endovascular treatment of ruptured intracranial aneurysms: comparison of results with GDC and matrix coils in CLARITY series
Authors: Cognard C 
Published: December 2010

PurposeTo compare the quality of immediate anatomical results after the endovascular treatment of ruptured aneurysms using GDC and matrix coils in CLARITY series.MethodsPostoperative anatomical results were evaluated on digital subtraction angiography, anonymously and independently by two experienced neuroradiologists. Two different scales were used: the Montreal scale and a new scale specifically designed for the present study (CLARITY scale).Results401 aneurysms were treated using GDC coils and 373 using matrix coils. Immediate anatomical results (Montreal scale) were not significantly different with GDC or matrix coils. In the GDC group, the result was complete occlusion for 197 aneurysms (49.1%), neck remnant for 155 aneurysms (38.7%) and aneurysm remnant for 49 aneurysms (12.2%). In the matrix group, the result was complete occlusion for 168 aneurysms (44.9%), neck remnant for 171 aneurysms (45.7%) and aneurysm remnant for 35 aneurysms (9.4%). Similar results were obtained using the CLARITY scale.The factors affecting the quality of aneurismal occlusion have been studied in both the GDC and matrix groups.ConclusionsThe postoperative occlusion after endovascular treatment of ruptured aneurysms is satisfying with a high percentage of complete occlusion or neck remnant in both the GDC (87.8%) and matrix (90.6%) groups.
O-017 Effect of biomechanical environment in vessel wall on stent restenosis
Authors: Terao M , Shobayashi Y , Goto S , Tateshima S , Sudo R , Tanishita K 
Published: December 2010

IntroductionStenting has become a standard procedure to treat atherosclerotic vessels. However, restenosis is reported in approximately one-third of patients treated with intracranial stenting, and its avoidance is drawing attention. The cause of restenosis includes vessel injury due to pressure from stent expansion and neointimal thickening due to decrease in vessel wall shear stress (WSS). Although the severity of vessel injury is proportional to neointimal thickness and restenosis, they are discussed separately. The object of this research is to examine the stress concentration and wall shear stress by a numerical analysis and reveal their configuration dependent relationship and effect to stent structure.Materials and methodsA commercial open cell coronary stent model was used in this research to make a comparison with other research. Firstly, stent expansion in an intact vessel was simulated by the finite element method and the stress distribution of stented vessel was analyzed. Next, computational fluid dynamics was conducted to examine blood flow and WSS distribution. Furthermore, stent structure was modified to improve stress concentration and WSS. Stress concentration was avoided by connecting adjacent stent struts and making a closed cell model. This model was named model 1. In contrast, low WSS was avoided by reducing the number of stent struts in the longitudinal direction, named model 2. Vessel stress and WSS distribution was examined to look into the effect of stent structure on vessel stress and WSS.Results and discussionVon Mises stress and WSS distribution of stented arterial lumen is shown in Abstract O-017 figure 1. Localized radial stress and low WSS, below 1 Pa, was observed around intersections of stent struts after stent expansion. Since endothelial cells and internal elastic lamina within the vessel is deformed in the same area, vessel injury is implied. Moreover, decrease in WSS and hoop stress was observed throughout the stented vessel lumen. Like WSS, hoop stress promotes neointimal thickening. Therefore, restenosis is assumed due to the interaction of vessel injury and neointimal thickening. Also, the modified model 1 moderated stress concentration but induced low WSS. On the other hand, model 2 improved low WSS in the vessel lumen but stress concentration was observed. It is presumed that stress concentration improves when the contact area of the stent strut increases whereas the area subjected to low WSS increases with the addition of contact area of stent struts. Therefore, a stent design with connected and reduced stent struts is feasible to avoid restenosis.Abstract O-017 Figure 1
O-020 Preliminary experience with a novel neck bridge device for bifurcation aneurysm treatment
Authors: Tateshima S , Turk A 
Published: December 2010

BackgroundEndovascular stenting for wide necked aneurysms has become common practice since the release of the Neuroform and more recently the Enterprise stent systems. However, intrinsic to their design, these devices are indicated for the treatment of side wall aneurysm morphologies. We present a novel neck bridge device that recently received HUD approval that simulates a stent for the treatment of bifurcation aneurysms.MethodsThis novel neck bridge device composed of several nitinol wires formed to create a virtual saddle shape that covers the ostium of a bifurcation or terminal configuration aneurysm. The device is designed to deliver through a 0.021″ microcatheter and is resheathable/recaptureable up until detachment so it can be used temporarily or detached and left permanently. Multiple human basilar wide necked aneurysms were mechanically simulated in a silicone benchtop model. The device was deployed across the aneurysm ostium and detached. Then an SL-10 microcatheter was advanced across the neck bridge device and into the aneurysm, and aneurysm coiling performed using standard techniques. Next, these same steps were repeated in two experimentally created bifurcation aneurysms in canines. These animals were then survived for 60 days and explanted. Further animal work is currently underway and those results will be presented if available.ResultsThe saddle neck bridge device was able to be successfully and easily deployed across the aneurysm neck in all instances. All aneurysms were able to be catheterized and coiled without difficulty. In no instance was there prolapse of coil loops through or around the device. Histologic evaluation demonstrated neoendothelial growth over the device struts without evidence of overt or abnormal inflammation or vessel trauma.ConclusionThe saddle neck bridge device is a novel endovascular stent like device that is designed to treat bifurcation aneurysms. Preliminary benchtop and animal modeling demonstrate the device to be safe and feasible for bifurcation aneurysm treatment. It is likely that this device in combination with coils will allow treatment of many aneurysms not treatable by coils alone.Abstract O-020 Figure 1
O-021 Significant improvement in patient functional outcome after revascularization of the middle cerebral artery by mechanical thrombectomy
Authors: Frei D , Bellon R , Kulcsar Z , Bonvin C , Rufenacht D , Alfke K , Stingele R , Jansen O , Madison M , Struffert T , Dörfler A , Grunwald I , Reith W , Haass A , Hsu D , Tarr R 
Published: December 2010

PurposeThe extent to which acute ischemic stroke patients' functional outcome can be improved by mechanical thrombectomy remains controversial. This is due in part to the lack of appropriate control groups in trials with these devices. The purpose of this study was to assess the effect of the novel mechanical thrombectomy device, the Penumbra System, on patient 90 day outcome and compare the results with an appropriate control group from peer reviewed literature.Methods and materialsThis study was a retrospective case review of 89 consecutive patients at seven international centers with occlusion of the middle cerebral artery (MCA) who were treated with the Penumbra System. All patients reviewed presented to the hospital within 8 h of symptom onset with a treatable MCA occlusion (TIMI 0 or 1). The primary end point was good functional outcome, as defined by a modified Rankin Scale (mRS) score of 2 or less at 90 days postprocedure. Published results from the placebo patients in the PROACT II trial were used as the historical control.ResultsMean baseline values at enrollment were: age 66 years, median National Institutes of Health Stroke Scale (NIHSS) score 15 (range 5–25), 51% were females and the median time from symptom onset to arterial puncture was 4.5 h. After use of the Penumbra System, 88% of the treated vessels were revascularized to TIMI 2 or 3. At discharge, 37% of patients had an NIHSS score of 0–1 or an improvement of at least 10 points. Six procedural serious adverse effects were reported in 89 patients (7%). There were a total of five (6%) symptomatic intracerebral haemorrhages reported at 24 h. At 90 days, all cause mortality was 15%. Of the 70 patients who either died or reached the 90 day follow-up, 36 (51%) had mRS scores of ≥2. Abstract O-021 table 1 shows the comparisons with the placebo patients from the PROACT II trial (JAMA1999;282:2003–11).Abstract O-021 Table 1Comparisons with the placebo patients from the PROACT II trialPROACT II placebo (n=59)Penumbra MCA group (n=89)p Values*Age (years) (mean)64660.4097Female (%)39510.1814Baseline NIHSS (median (range))17 (4–28)15 (5–25)NATIMI 2–318%88%<0.0001Symptomatic ICH2%6%0.4026mRS< at 90 days25%51%0.0037Death at 90 days27%15%0.0895*p value is for testing against PROACT II placebo using a two tailed Fisher's exact test.ICH, intracerebral hemorrhage; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale.ConclusionsThese results suggest that when an appropriate group is used as the control, successful revascularization by the Penumbra System is associated with better functional outcome and survival.
O-023 Asymptomatic intracranial hemorrhage after endovascular therapy for acute ischemic stroke is associated with worse outcomes
Authors: Gupta R , Nogueira R , Jovin T , Levy E , Rai A , Liebeskind D , Hsu D , Rymer M , Zaidat O , Tayal A , Lin R , Natarajan S , Nanda A , Hirsch J , Abou-Chebl A , Kalia J , Nguyen T , Chen M , Yoo A 
Published: December 2010

Background and purposeThe use of endovascular techniques to treat large artery occlusion in acute ischemic stroke has become more frequently employed as a treatment option. We sought to determine the predictors of intracranial hemorrhage after these procedures were performed.MethodsThis is a retrospective review of data from 13 high volume stroke centers that perform endovascular treatments for acute ischemic stroke. Patients with anterior circulation strokes treated under 8 h from symptom onset with endovascular therapy were included. Hemorrhages were classified as parenchymal hematoma (PH) types 1 and 2 and hemorrhagic infarction (HI) types 1 and 2. Patients with PH bleeds were considered symptomatic and HI bleeds were asymptomatic. Binary logistic regression modeling was performed to determine the variables associated with symptomatic and asymptomatic hemorrhages after correcting for multiple comparisons.ResultsA total of 1122 patients met the inclusion criterion for this study. Mean age for the cohort was 67±15 years with a median National Institutes of Health Stroke Scale (NIHSS) of 17 (IQR 13–20). The distribution for thrombus location at the initiation of endovascular therapy was as follows: M1 segment of the middle cerebral artery (MCA) 561 (50%), carotid terminus 214 (19%), M2 MCA 171 (15%), tandem occlusions 141 (13%) and isolated extracranial internal carotid artery occlusion 35 (3%). Parenchymal hematomas occurred in 96 (8.5%) patients and HI in 265 (24%) patients. There were no variables associated with symptomatic hemorrhages while the following variables were predictors of asymptomatic hemorrhage: diabetes mellitus (OR 2.02; 95% CI 1.46 to 2.79; p<0.0001), preprocedural use of intravenous tissue plasminogen activator (tPA) (OR 1.61, 95% CI 1.17 to 2.21; p<0.003), intra-arterial thrombolytic infusion (OR 1.52, 95% CI 1.09 to 2.10; p<0.01), higher baseline NIHSS (OR 1.032, 95% CI 1.001 to 1.06; p<0.04) and use of the Merci device (OR 1.71, 95% CI 1.18 to 2.48; p<0.003). After controlling for age, baseline NIHSS, recanalization status, PH, type of sedation and site of occlusion, the presence of asymptomatic hemorrhage was associated with a poor clinical outcome (OR 2.23, 1.53 to 3.23; p<0.0001).ConclusionsDiabetic patients and those who have been treated with intravenous tPA prior to the procedure or intraprocedural use of thrombolytics or the Merci device appear to be at a higher risk for asymptomatic hemorrhage. Moreover, patients with asymptomatic hemorrhage appear to be at a higher risk for a worse clinical outcome at the 90 day follow-up.