bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-016 Mycotic aneurysms of the cerebrovasculature: experience at a high volume center
Authors: Hui F , Gordon S , Ammar T , Jin Y , Moskowitz S 
Published: July 2011

IntroductionMycotic aneurysms of the cerebrovascular system are an uncommonly encountered entity, more often seen in patients with infective endocarditis. While it has been estimated that ruptured mycotic aneurysms result in 5% of the neurologic complications of infective endocarditis, no definitive screening protocol for patients with infective endocarditis has been established, nor is there a universally accepted treatment paradigm.MethodsThis is a retrospective review of 169 patients who underwent cerebral angiography with a diagnosis or presumptive diagnosis of infective endocarditis or left ventricular assist device at the Cleveland Clinic spanning from January 2003 to March 2010 in accordance with institutional IRB guidelines. Chart review and review of imaging was performed, identifying patient demographics, presence of occlusions, mycotic aneurysms and treatment modality.ResultsThere were 16 (9.46%) patients harboring mycotic aneurysms out of 169 patients on angiography. Out of these, 15 presented with hemorrhage (93.7%), and 10 (66.6%) had acute ischemic findings on tomographic imaging. Vegetations were seen on the atrial valve in 6 (37.5%) of the patients and on the mitral valve in 9 (56.2%), with one patient with a left ventricular assist device (6.25%). There were three rehemorrhages (20%) in the aneurysms that presented with hemorrhage, two of which were in during conservative management, one post aneurysm excision. With regards to treatment, 7/16 were treated with excision, 2/16 by embolization, and the remainder by conservative management. In the 156 patients without angiographic evidence of mycotic aneurysm, 48/156 (30.7%) had evidence of hemorrhage, while 115/156 with evidence of stroke, TIA or amaurosis fugax (73.7%). There were 3/156 rehemorrhages (1.9%) in this group. In patients that presented with hemorrhage, 15/63 (23.8%) harbored an aneurysm, while in patients presenting with ischemic changes, it was 10/166 (6%).ConclusionPatients with infective endocarditis or similar sources of bacterial emboli are prone to neurovascular complications of either hemorrhage or ischemia. Presentation with hemorrhage and endocarditis appears to be more predictive of an underlying aneurysm. As such, in patients with infective endocarditis, presentation with intracranial hemorrhage should prompt vascular imaging. An optimal treatment paradigm has yet to be established.
P-019 Preoperative embolization of intracranial tumors using Onyx
Authors: Dashti S , Yao T 
Published: July 2011

IntroductionTumor surgery in the central nervous system is often filled with complexities. Some tumors are particularly hypervascular and may pose an added level of difficulty to surgical resection; in these cases preoperative embolization may assist the surgeon in accomplishing better resection with lower surgical blood loss. With the refinement of endovascular techniques, embolization of tumors has become more efficacious and safe. Liquid embolic agents are particularly appealing, as they allow greater control and penetration into the tumor mass. In this series, the authors report their experience with patients undergoing preoperative intracranial tumor embolization with Onyx liquid embolic agent.MethodsWe retrospectively reviewed the records of all patients undergoing preoperative intracranial tumor embolization at our institution between 2009 and 2011. Transarterial Onyx embolization was used in all cases.Results11 patients underwent preoperative embolization in the last year: eight meningiomas and three glomus tumors. All meningiomas were embolized through the middle meningeal artery. Extensive penetration was achieved in all glomus tumors, but in none of the meningiomas. Meningioma onyx penetration was moderate in 2, mild in 3, and proximal in 2. There was one major procedure-related morbidity: optic nerve ischemia secondary to non-target embolization of the ophthalmic artery through anastomotic channels with the meningeal artery. This resulted in near-complete vision loss in the affected eye. There was no procedure-related mortality. Median estimated blood loss from subsequent surgery was 300 ml.ConclusionPreoperative embolization of central nervous system tumors with Onyx liquid embolic agent can be performed relatively safely and effectively in selected patients. The main advantage of Onyx over other embolizates is the superior control and extensive penetration that can be achieved in hyper-vascular tumors such as glomus tumors. This converts a very bloody lesion to an avascular Onyx cast that allows surgical resection with significantly reduced blood loss. Non-target vessel embolization remains the main complication. There may be a decreased risk of hemorrhagic complications when compared to particle embolization.
P-020 SILK flow diverter-beginner's perspective
Authors: Shankar J , Vandorpe R , Pickett G , Fleetwood I , Schmidt M , Maloney W 
Published: July 2011

PurposeFlow diverters are the latest technology in the treatment of difficult/so far untreatable aneurysms. As with all new technologies, there is lots of “hype” factor for flow diverters as well. For a beginner in the field of interventional neuroradiology, it is usually not advisable to venture into the difficult cases in the beginning of the carrier. However for a new technology, every body is a beginner. The purpose of this presentation is to discuss important points that a beginner in the field should know about how to proceed for the SILK flow diverter technology.Materials and MethodWe treated a total of seven patients with aneurysms which were branded as non-treatables or extremely difficult to treat with the conventional treatment techniques. Before actually starting the treatment, the most important point is to educate and make a consensus among the vascular neurosurgeons and interventional neuroradiology. Organizing an in-service with the company is helpful in this. Getting approval from healthcare regulatory agency (Health Canada) and proctorship are the next steps. The most important part for a new technology is proper case selection. Management of the patient per se starts with talking with the patient about the technology, the rationale for its use and lack of its long term outcome. This is followed by the periprocedural management most important being the anti-platelet medications and steroids. Eventually the follow-up is the most important step to maintain the credibility of both the new treatment and the new operator.ResultThe aneurysms in our patient group were located at cavernous/ophthalimic segment of internal carotid artery (n=5), basilar trunk (n=1) and A2 segment of anterior cerebral artery (n=1). Five of these patients were done under the guidance of the proctor and last two patients were done independently. We had 100% technical success. No technical complications. One patient had mild hemiparesis which improved over a period of next 5 days. Another patient had spontaneous occlusion of her parent artery 2 months after the treatment as she stopped taking antiplatelet drugs. Other patient had no complications. All patients were followed up using CEMRA to begin with and the confirmation of complete occlusion was validated using DSA. We had an average follow-up of 3 months (0 to 7 months). One patient had confirmed exclusion of his aneurysm on MRI 3 months after the initial treatment and other patient had occlusion of her parent artery 2 months after the initial treatment.ConclusionEducation, proper training, proper case selection, patience and team support are the most important factors to consider when venturing into a relatively new territory in the first year of your carrier.
P-021 Safety and efficacy of balloon-assisted coil embolization of intracranial aneurysms: a single institution experience
Authors: Santillan A , Mazura J , Riina H , Gobin Y , Patsalides A 
Published: July 2011

PurposeThe safety of the balloon remodeling technique remains a matter of debate. In this report we analyze the safety of the balloon remodeling technique compared with coil embolization alone for the treatment of ruptured and unruptured intracranial aneurysms.Material and MethodsWe retrospectively reviewed the medical records, procedures notes, and angiograms of 491 patients treated with coil embolization alone and the balloon remodeling technique from March 2002 to March 2010 at the Division of Interventional Neuroradiology at NYPH/Weill Cornell Medical Center. The aneurysms were classified in two groups according to the size of the aneurysm dome: 7 mm or less and larger than 7 mm. A wide-necked aneurysm was defined as a neck diameter >4 mm or a dome-to-neck ratio <1.5 mm. The adverse events were classified in three groups: thromboembolic events, intraprocedural ruptures, and device-related problems. Clinical outcomes of these adverse events were classified as none, transient or permanent neurologic deficit and death.ResultsA total of 491 aneurysms (371 women, 120 men; mean age, 55.36±12.35 [SD]; range, 11–92 years) were embolized. 236 aneurysms were treated using the balloon remodeling technique, however; in 8 cases (3.4%) the balloon placement failed. Of the 491 treated aneurysms, 274 aneurysms (55.8%) presented with a previously ruptured aneurysm. 303 aneurysms (61.8%) measured 7 mm or less and 187 (38.2%) were larger than 7 mm. Dome-to-neck ratio was 1.5 or less in 169 (34.4%) and >1.5 in 322 patients (65.6%). Thromboembolic events, intraprocedural rupture, and device-related problems were encountered in 12 (2.4%), 19 (3.9%) and 16 (3.3%) patients respectively, for both treatment modalities. The rate of adverse events related to the balloon remodeling technique was seen in 26 cases (5.3%) compared to coil embolization alone that was 21 cases (4.3%). Patients treated with coil embolization alone were more likely to have a previously ruptured aneurysm compared to the balloon remodeling group (67.8% vs 42.8%). There was no statistical difference between both groups after treatment of aneurysms with a dome to neck ratio <1.5 (p=0.88, χ2test). The risk of thromboembolic events was the same in both groups (OR=0.92; 95% CI 0.29 to 2.91; p=0.89). A trend toward a lower risk of intraprocedural rupture was observed in the coil embolization group, but the results were not significant (OR=0.53; 95% CI 0.20 to 1.36; p=0.19). There was no statistical difference detected for the risk of device-related problems in both groups (OR=0.92; 95% CI 0.34 to 2.50; p=0.88).ConclusionsThe balloon remodeling technique does not increase the risks of periprocedural complications associated with endovascular embolization of intracranial aneurysms.
O-006 Pharmaco-mechanical clot disruption using a balloon infusion wire in an acute rabbit common carotid artery thromboembolic occlusion model
Authors: Gounis M , Nogueira R , Mehra M , Finol E , Yang Y , Jahrmarkt S , Migliuolo M , Wakhloo A 
Published: July 2011

PurposeRecanalization using intra-arterial fibrinolytic therapy in combination with mechanical clot disruption may be a more effective strategy for early reestablishment of cerebral blood flow in acute ischemic stroke. To validate our hypothesis, we evaluated a prototype balloon infusion wire (NeuroInterventions, Pittsburgh Pa) for delivering rtPA directly within the clot and compared its performance with the HyperGlide compliant balloon (eV3 Neurovascular, Irvine, CA) and microcatheter directed rtPA infusion in a rabbit common carotid artery (CCA) thromboembolic occlusion model.Materials and MethodsNew Zealand white rabbits (n=7) were selected for this work due to their similar response to rtPA as in humans. They were anesthetized and >50% luminal stenosis of the CCA was created bilaterally with 3-0 silk suture. Allogenic clot was injected through a 6F guide catheter and lodged consistently in the CCA proximal to the stenosis (arrows, A). The stenosis was released one hour post clot injection allowing sufficient time for clot-vessel lumen interaction. DSA was performed bilaterally to confirm the occlusion and assess the Thrombolysis in Cerebral Infarction (TICI) score. Each vessel was assigned to receive the device, balloon angioplasty, or microcatheter directed rtPA. The negative control group received no therapy. The primary endpoint was flow restoration. The secondary endpoint was time to recanalization and vascular safety, which was assessed by histological response on luminal scanning electron microscopy (SEM) and H&E staining. An assessment of the vascular safety from controlled operation of the infusion device and balloon occlusion in unembolized rabbit CCA was also made.ResultsWe successfully created consistent thromboembolic occlusions with TICI 0 flow at the predetermined location within the CCA. The balloon infusion wire achieved an earlier recanalization with a TICI 2B score (B, 2D perfusion post MTT) in 14 min requiring 2.8 mg rtPA. In comparison, microcatheter directed rtPA achieved TICI 2B score in 29 min requiring 4 mg rtPA. Balloon angioplasty, when used alone, achieved an inferior TICI 2A final recanalization score in 20 min post treatment and often failed to recanalize the CCA. Histomorphometry and luminal SEM evaluation revealed that the operation of the infusion device is comparable to balloon angioplasty with endothelial cell denudation and an exposure of the internal elastic lamina, an acceptable level of disruption for mechanical revascularization devices.ConclusionCombined pharmaco-mechanical disruption achieves a high recanalization grade with a lower thombolytic dose more rapidly in comparison to either therapy (balloon angioplasty and thrombolysis) used alone.Abstract O-006 Figure 1
P-026 Avoiding perils during endovascular embolization of skull base tumors: a pictorial review
Authors: Cho A , Pakbaz R , Green D 
Published: July 2011

IntroductionEndovascular embolization in the external carotid artery territory has become a widely accepted treatment for preoperative embolization of head and neck tumors. Tumors about the skull base present a difficult task to the endovascular surgeon because of extent of disease at presentation, and proximity to foramina with transiting cranial nerves and important blood vessels. External carotid to intracranial artery communications present potential for disastrous complications during embolization procedures. Understanding embryology and regular review of high quality images clearly demonstrating these communications are key to real time recognition during embolization and thus avoiding potential complications.MethodsRetrospective institutional review of endovascular embolization for tumors and vascular malformations about the skull base. Illustrative cases demonstrating dangerous extracranial-intracranial anastamoses and cranial nerve blood supply were identified are presented for review.FindingsPre-embolization identification and or exclusion of dangerous extracranial to intracranial anastamoses and blood supply to cranial nerves was possible in all cases. Angiographic identification of these vessels facilitated appropriate vessel selection and catheter positioning for safe embolization.ConclusionReal time ability to identify external carotid territory artery to intracranial artery anastamoses and blood supply to cranial nerves about the skull base allows for effective embolization and avoidance of associated complications from inadvertent vessel embolization.
E-004 Safety and efficacy of transluminal balloon angioplasty using a compliant balloon for severe cerebral vasospasm after an aneurysmal subarachnoid hemorrhage
Authors: Lee T , Sung S , Choi C 
Published: July 2011

PurposeVasospasm of cerebral vessels remains a major source of morbidity and mortality after an aneurysmal subarachnoid hemorrhage. The purpose of this study was to evaluate the safety and efficacy of transluminal balloon angioplasty (TBA) for subarachnoid hemorrhage-induced vasospasm.Materials and Methods11 patients with an angiographically confirmed significant vasospasm (>50% vessel narrowing and clinical deterioration) were studied. A total of 54 vessel segments with significant vasospasm were treated by TBA. Digital subtraction angiography was used to confirm the presence of vasospasm, and TBA was performed to dilate vasospastic arteries. Medical and angiographic reports were reviewed to determine technical efficacy and for procedural complications.ResultsBalloon angioplasty using Hyper-Glide or Hyper-Form balloons (MicroTherapeutics, Irvine, California, USA) was successfully accomplished in 88.9% vasospastic segments (48 of 54), namely, in the distal internal carotid artery (100%, n=7), the middle cerebral artery (100%), including the M1 (n=10), M2 (n=10), and M3 segments (n=4), in the vertebral artery (100%, n=2), basilar artery (100%, n=1), and in the anterior cerebral artery, including the A1 (66%), A2 (66%), and A3 segments (100%). Vessel diameters significantly increased after TBA. No vessel rupture or thromboembolic complications occurred. GCS at 1st day after TBA is improved in all patients except one.ConclusionThis study suggests that TBA using Hyper-Glide or Hyper-Form balloons is a safe and effective treatment for subarachnoid hemorrhage-induced cerebral vasospasm.
E-008 Novel approach to endovascular repair of complex iatrogenic V3 vertebral AVF using amplatzer II plug and PGLA- coated coils: a case report
Authors: Whapham J , Asiri A , Ahmed H 
Published: July 2011

The concomitant vertebral artery injury as a complication during posterior C1&2 screw fixation has been described before and found to occur in approximately 3% of cases and may remain asymptomatic (30%) or cause sequelae that include an arterial steal phenomenon with cerebral hypoperfusion, increased flow in cerebral veins resulting in intracranial venous congestion or hemorrhage, headaches, a bruit, tinnitus or vertigo. The nature of the fistula and its associated symptoms, the onset and nature of the injury and the concurrent clinical status of the patient, and the necessity of treatment, these factors influence choosing the treatment modality and approach which range between conservative management, endovascular techniques to occlude the fistula, and/or on rare occasions direct surgical clipping could be used also, see Abstract E-008 table 2 in (Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils. 1999), E-008 tables 1 and 2 in (Herreraet al., 2008). Variable endovascular techniques have been described in many publications, (Kattner, Roth, Nardone, & Giannotta, 2004), (Gonzalezet al., 2001), (Leeet al., 2007), (Beaujeuxet al), (Feyyaz Baltacıoğlu, 2009), (Chuhan Jiang, Xianli Lv, Youxiang Li, Jingbo Zhang, Zhongxue Wu, 2009), (Macdonald, Millar, & Barker, 2010), (Andreou, Ioannidis, & Nasis, 2008), (Liet al., 2007), (Guoet al., 1998). In this case, we are first to report the practical use of Amplatzer Vascular Plug (II), which has been only known to be used in treating peripheral vascular AVF, and it has never been reported to be used in treating AVFs until the time of submitting this case-report. Amplatzer Vascular Plug Family, are designed to provide optimal embolization of peripheral veins and arteries through single device occlusion, full cross-sectional vessel coverage, controlled and precise deployment. Using the Amplatzer Vascular plug is a very efficient and cost-effective alternative to coils or surgery. It can also be repositioned or recaptured, if necessary. The Amplatzer Vascular Plug (II), is a unique multi-segmented, multilayered device, that reduces the time to occlusion for transcatheter embolization procedures. Its adjustable lobes are designed to better conform to vessel landing zone. (AGA medical corporation, 2010), (Cil B, Peynircioğlu B, Canyiğlit M, Geyik S, Ciftçi T., 2008).ConclusionUsing Amplatzer Vascular Plug (II) in treating vertebral AVFs has never been previously reported. In this case; the large size of the AVF and the and the altered and complicated vertebral vascular anatomy secondary to the previous cervical surgeries were strong indications to choose a larger vascular plug in attempt to cause a complete occlusion of the AVF and attempt complete cure of its clinical sequelae on our patient.
E-010 Features of dissections on high resolution MRI
Authors: Hui F , Mahmoud S , Toth G , Ken U , Hajj-Ali R , Jones S 
Published: July 2011

IntroductionHigh resolution MR imaging has been used to evaluate vessel walls in atherosclerotic disease as well as vasculitides in order to characterize wall thickness and enhancement. High resolution MRI may also be useful in characterizing dissections and may offer additional information not available from catheter angiography.MethodsThis is a retrospective review of 75 patients who underwent high resolution contrast enhanced imaging of the neurovasculature. Four patients with a history of dissection were included in this retrospective review. Re analysis of the exams was performed by two attending neuroradiologists with comparison to other relevant imaging modalities including cerebral angiography, conventional magnetic resonance and CT.ResultsImages from the high resolution magnetic resonance examinations demonstrate wall enhancement in dissected vessels as well as the dissection flap. The dissected vessel walls demonstrate robust enhancement even in the early phases. Static or slow flowing blood may interfere with the nulling effect of the saturation pulse, so high signal of intravascular components should be interpreted with care. Intravascular thrombus was identifiable in one case that was not detectable on cerebral angiogram. Wall thickness and outer diameter can be assessed on HRMR.ConclusionHigh Resolution MRI of intracranial dissections may yield information about angioarchitecture not discernible by conventional imaging. Further investigation is warranted.