bluuebunny/crossref_metadata_2025_split huggingface dataset:
O-022 Reopening the chronically occluded basilar artery
Authors: Albuquerque F , McDougall C 
Published: December 2010

IntroductionOcclusion of the basilar artery (BA) has a poor prognosis. We evaluated technical considerations and complications associated with reopening subacute to chronically occluded BAs.MethodsDuration of BA occlusion before revascularization, symptoms and medical management before treatment, and postprocedural antiplatelet regimen and anticoagulation protocols of 10 patients were analyzed. All patients underwent attempted Gateway angioplasty followed by Wingspan stenting (Boston Scientific, Fremont, California, USA).Results10 patients, including seven men and three women, were treated from 2004 to the present. They ranged in age from 29 to 80 years with a mean of 62. The median time between onset of symptoms to treatment ranged from 4 to 150 days (mean 50 days). Recanalization was successful in 8/10 patients. Immediately following the procedure, seven patients were either improved or stable, and three were worse. Of these three, two died of procedure related complications and one suffered a mild brainstem stroke from which she has made a substantial recovery. A third patient died in a delayed fashion of unrelated causes. Three subacute complications occurred. These included: one acute thrombosis of the stent requiring emergent repeat angioplasty, one symptomatic basilar dissection requiring placement of a second stent 1 week after the original procedure and one mild recurrent stroke after delayed stent occlusion. Of the seven surviving patients, five are improved or stable. The other two patients are mentioned above and suffered a mild brainstem procedurally related stroke and the other a delayed stroke as a result of re-occlusion.ConclusionWith current endovascular techniques, recanalization of the subacute and chronically occluded basilar artery is feasible. The procedure carries substantial risks and should be reserved for patients with medically refractory symptoms. Careful postprocedural medical management and radiographic follow-up are warranted do prevent in-stent restenosis.
O-024 Clinical outcome in stent versus balloon assisted unruptured aneurysm coiling in the ECOSA Multicenter Study
Authors: Owais M , Zaidat O , Noquiera R , Levy E , Xavier A , Linfante I , Gupta R , Edgle R , Nguyen T , Mueller-Kronast N , Tong F C , Hsu D P , Dion J E , Cawley C M , Batista L M , Natarajan S , Rayes M , Etezadi V , Chowdhry S , Norbash A 
Published: December 2010

Background and objectiveCerebral aneurysm with endovascular coil embolization is a well established treatment modality. Endovascular therapy can be complex with primary coiling versus stent or balloon assisted coil embolization. Limited data exist that compares the safety and clinical outcome of balloon versus stent assisted coiling of cerebral aneurysm. This is a substudy of the large Endovascular Coil Embolization of Small Unruptured Cerebral Aneurysm (ECOSA) study comparing stenting versus balloon assisted coiling in a large multicenter cohort.MethodData from 11 US medical centers are collected on technical and procedural outcome of unruptured small cerebral aneurysm coiling (<7 mm) with the selection for comparison the subgroups of stenting and balloon assisted coiling. Data on clinical baseline variables and periprocedural outcome of thromboembolic event (TEE) and procedural rupture is collected and compared between the two groups in univariate and multivariate analysisResults351 patients were identified to have an adjunctive device use for coiling cerebral aneurysm. 247 underwent stent assisted coiling and 104 underwent balloon assisted coiling.Mean age of the stenting group was 55.6±11 versus 53.5±12.5 for the balloon group (p value 0.06). The majority were women with 75.7% in the stenting and 77.8% in the balloon group, and the majority were white (73.4%). Mean size of the aneurysm in the stenting group was 5 mm±1.2 mm versus 4.6 1.2 mm for the balloon (p=0.003).Overall events rate of all TEE and rupture complications were 4.2% for the stenting versus 1.6% for the balloon (p=0.02); there was a difference in the symptomatic complication of TEE or rupture.ConclusionContrary to the other literature, in our retrospective large case series comparing stent versus balloon assisted coiling, the event rate of TEE and rupture were significantly higher in the stent group. A larger prospective study is needed to confirm this result.
O-025 The Trevo device: preclinical data of a novel stroke thrombectomy device in two different animal models of arterial thrombo-occlusive disease
Authors: Nogueira R , Levy E , Gounis M , Siddiqui A , Duckwiler G 
Published: December 2010

IntroductionThe currently available mechanical devices fail to achieve recanalization in as many as 20–40% of proximal arterial occlusion strokes. We now report on the preclinical evaluation of the safety and efficacy of a novel thrombectomy device designed to achieve immediate flow restoration by quickly removing clot.MethodsFour confirmatory animal studies were performed with the Trevo Device (Concentric Medical Inc, Mountain View, California, USA) in the swine (n=2) and canine (n=1) models of arterial thrombo-occlusive disease employing autologous thrombin generated thrombi. The angiographic response and the degree of device clot incorporation were evaluated. High resolution flat panel three-dimensional CT was performed to further define the in vivo device–thrombus–vessel interaction. Finally, samples of three swine vessels treated with six passes of the device were explanted for histopathological analysis.ResultsA total of 16 clots of variable hardness and consistency were implanted in a variety of vascular settings, including the swine internal maxillary, lingual and forelimb arteries as well as the canine external carotid and vertebral arteries. TIMI 2–3 reperfusion was achieved in all cases immediately after device deployment. All 16 clots were retrieved after one (n=15) or two (n=1) passes with the device. Histopathological analysis demonstrated severe disruption of the intima but no hemorrhage of media or adventitia.ConclusionOur experimental data suggest that the Trevo Device is highly effective at achieving immediate reperfusion of occluded arteries without causing any clinically significant disruption of the vascular integrity. Initial human clinical evaluations of the Trevo Device in acute ischemic stroke patients are underway.Abstract O-025 Figure 1Example of in vivo device–clot–blood vessel interaction. (A) Road map angiography of the swine left lingual artery. (B) High resolution flat panel CT three dimensional reconstruction. Arrows: proximal (black) and distal (white) radiopaque markers of the Trevo Device. Arrowhead: radiopaque thrombus. (C) Axial cut reconstruction of the area identified by the arrowhead in (B) showing complete incorporation of the radiopaque thrombus (arrowhead) through the struts of the Trevo Device.
O-026 Balloon assisted coiling of intracranial aneurysms: complication comparison between non-assisted and balloon assisted procedures
Authors: Perl J , Fease J , Tubman D , Crandall B 
Published: December 2010

Background and purposeThere is still a question in the current literature as to whether the addition of balloon assistance in intracranial aneurysm embolization procedures increases thromboembolic and intraoperative perforation complications. The purpose of this study was to determine if balloon assisted coiling (BAC), given the use of an additional device, increases complications compared with conventional coiling of intracranial aneurysms.MethodsBetween June 2002 and February 2010, 845 consecutive intracranial aneurysm embolization procedures were assessed. Of these procedures, 640 (207 ruptured) procedures had a high compliant balloon (Hyperform (73.8%) or Hyperglide (25.8%); eV3 Corp) inserted during the procedure; 205 (127 ruptured) procedures had no adjunctive devices inserted during the course of the procedure. Procedures utilizing stent assistance were excluded from the study. Procedures were performed by three different interventionalists at a single center. Procedural thromboembolic complications, intraoperative perforations, hospital course complications and Glasgow Outcome Score were reviewed and recorded retrospectively and prospectively. Comparisons between the techniques were also made between ruptured and unruptured aneurysms. Results were analyzed using the Student t test; p values <0.05 were considered statistically significant.ResultsWith BAC, 88.8% of procedures had no complications whatsoever (85.0% ruptured, 90.5% unruptured) and with conventional coiling, 84.9% (80.1% ruptured, 92.3% unruptured) (p=0.168) of procedures had no complications. Thromboembolic complications with clinical sequelae occurred more during conventional coiling (7.3%; 15/205) than BAC (1.1%; 7/640) (p=0.001). Intraoperative perforation occurrences were not statistically significantly different (2.8% BAC versus 1.5% conventional coiling; p=0.20)). Of the intraoperative perforations with BAC, only 38.9% (7/18) occurred while the balloon was inflated. In 33.3% (6/18), the balloon was inflated only after perforation by coil or microcatheter. In 11.1% (2/18), the balloon was only inserted after the perforation had occurred, 5.6% (1/18) occurred during angioplasty and in 11.1% (2/18) extravasation was seen immediately after procedure termination. In the BAC procedures, 94.8% had no hospital course complications (90.8% ruptured, 96.8% unruptured) and in conventional coiling procedures, 85.9% (78.0% ruptured, 98.7% unruptured) had no hospital course complications. Glasgow Outcome Score in ruptured and unruptured aneurysms showed no statistically significant difference in BAC procedures compared with conventional coiling procedures.ConclusionThe use of balloon assistance in intracranial aneurysm embolization procedures does not increase technical or clinical complications compared with embolization procedures without balloon assistance.
O-027 Predictors of restenosis and periprocedural strokes during intracranial stent placement: a retrospective multicenter study
Authors: Hussain M , Kalia J , Malik A , Ching E Cheng , Teng Q , Lin R , Jovin T , Zaidat O , Gupta R 
Published: December 2010

Background and purposeIntracranial stenting and angioplasty has been increasingly utilized for the treatment of symptomatic intracranial atherosclerotic disease (ICAD). The use of self-expanding stents (SES) has been reported to have a high technical success rate but there are concerns with restenosis. We sought to determine if the use of balloon mounted stents (BMS) was associated with higher technical complication rates compared with self-expanding stents.MethodsThree academic institutions contributed data on patients treated for symptomatic ICAD over a 3 year period (2006–2009). 259 consecutive patients were identified. Demographics, type of stent placed, periprocedural complications, per cent stenosis prior to treatment and after treatment, if the treatment was within 2 weeks of clinical symptomatology, lesion classification with the Mori scale and follow-up imaging for restenosis were collected retrospectively. A univariate analysis was performed to determine predictors of periprocedural stroke and also for restenosis at follow-up. Variables with a p value <0.20 were entered into a binary logistic regression model to indentify independent predictors.Results259 patients with a mean age of 61±13 years with 168 (65%) patients presenting with strokes and the rest with transient ischemic attacks. The distribution of the lesions were as follows: vertebrobasilar 109 (42%), middle cerebral artery 85 (33%) and intracranial internal carotid artery 65 (25%). 79 (31%) BMS were implanted and 180 (69%) SES. A total of 17 (6.5%) patients developed a periprocedural stroke with no difference noted between use of type of stent. Patients in whom a BMS was implanted had a significant reduction in stenosis compared with SES (81±10% to 7±11% vs 80±12% to 24±9%; p<0.0001). The independent predictors of periprocedural stroke were as follows: treatment within 2 weeks (OR 2.5 (1.2 to 5.6); p<0.01), Mori B or C lesion (OR 6.7 (3.3 to 10.1); p<0.001) and patients with an index event of a stroke (OR 1.5 (1.2 to 3.4); p<0.018). The independent predictors of restenosis at follow-up were as follows: use of SES (OR 3.22 (1.40 to 7.41); p<0.006) and Mori B or C lesion (OR 3.97 (2.05 to 7.71); p<0.0001).ConclusionsThe use of BMS was not associated with higher complication rates but was associated with lower restenosis rates. Placement of stents in patients with more complex lesions is associated with higher periprocedural stroke rates and restenosis. Further prospective studies comparing BMS with SES are warranted.
O-032 Long-term outcomes in emergent cavernous carotid stent grafting: a series of 29 cases
Authors: Alexander M , Choulakian A 
Published: December 2010

IntroductionTraumatic injury to the cavernous carotid artery may be difficult to manage as it often requires emergent treatment due to the potential for life threatening hemorrhage. Since this segment of artery is difficult to access surgically, frequently endovascular treatment by either parent artery occlusion or stent grafting is necessary.MethodsThis is a prospective case series of 29 patients who had traumatic cavernous carotid injury or spontaneous hemorrhage who had placement of one or more stent grafts in the cavernous carotid artery for treatment. Patients were loaded with either 300 mg or 600 mg of clopidogrel and 325 mg of aspirin either a few hours prior to the endovascular procedure or via an oral gastric tube at the time of the procedure. Patient also received intraprocedure intravenous heparin. They were then maintained on clopidogrel and aspirin for 6 months and then aspirin alone from then on. Follow-up imaging was performed at 6 months post intervention, and patients were then followed up clinical on an annual basis.ResultsOf the 29 patients who had treatment, 10 patients had iatrogenic injury to the carotid artery from surgery with epistaxis, 14 patients had direct traumatic carotid cavernous fistula and two patients had epistaxis or subarachnoid hemorrhage from a gunshot wound. Three patients had prior malignant skull base tumor resection with radiation therapy that developed acute epistaxis. Two of the patients developed thromboembolic events within the first 30 days of treatment. With an average imaging follow-up of 2.7 years, two patients had asymptomatic occlusion of their stent grafts, 22 patients had patent stent grafts and five patients had no imaging follow-up.ConclusionsStent grafts provide a safe alternative to deliberate parent artery occlusion in patients with spontaneous hemorrhage or traumatic to the cavernous carotid artery. With aggressive antiplatelet therapy, a long term symptomatic thromboembolic rate of 7% was seen.
O-004 The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of good functional outcome in stroke patients with intracranial large vessel occlusion
Authors: Lima F , Furie K , Silva G , Lev M , Camargo É , Ay H , Singhal A , Harris G , Halpern E , Koroshetz W , Smith W , Yoo A , Nogueira R 
Published: December 2010

Background and purposeThe role of non-invasive methods in the evaluation of collateral circulation has yet to be defined. We hypothesized that a favorable pattern of leptomeningeal collaterals, as identified by CT angiography (CTA), correlates with improved outcomes.MethodsData from a prospective cohort study at two university based hospitals where CTA was systematically performed in the acute phase of ischemic stroke were analyzed. Patients with complete occlusion of the intracranial internal carotid artery and/or the middle cerebral artery (segments M1 or M2) were selected. Leptomeningeal collateral pattern was graded as a three category ordinal variable (less, equal or greater compared with the unaffected contralateral hemisphere). Univariate and multivariate analyses were performed in order to define the independent predictors of good outcome at 6 months (modified Rankin Score (mRS) ≤2).Results196 patients were selected. Mean age was 69±17 years and median National Institutes of Health Stroke Scale (NIHSS) score was 13 (IQR 6–17). In the univariate analysis, age, baseline NIHSS, pre-stroke mRS, Alberta Stroke Programme Early CT Score, admission blood glucose, history of hypertension, coronary artery disease, congestive heart failure, atrial fibrillation, site of occlusion and collateral pattern were predictors of outcome. In the multivariate analysis, age (OR 0.95; 95% CI (0.93–0.98); p=0.001), baseline NIHSS (OR 0.75; 0.69–0.83; p<0.001), pre-stroke mRS (OR 0.41; 0.22–0.76; p=0.01), intravenous recombinant tissue plasminogen activator (OR 4.92; 1.83–13.25; p=0.01) and leptomeningeal collaterals (OR 1.93; 1.06–3.34; p=0.03) were identified as independent predictors of good outcome.Abstract O-004 Figure 1Examples of robust and poor leptomeningeal collaterals. (A) Good leptomeningeal collaterals: 51-year-old male, initial National Institutes of Health Stroke Scale (NIHSS) of 12, modified Rankin score at 6 months: 1. (B) Poor leptomeningeal collaterals: 47-year-old female, initial NIHSS of 13, modified Rankin score at 6 months: 6. Arrows point to the site of occlusion at the middle cerebral artery (MCA)–M1. The strength of leptomeningeal collaterals is estimated by the degree of distal reconstitution of the MCA vessels.ConclusionConsistent with angiographic studies, leptomeningeal collaterals on CTA are also a reliable marker for good outcome in acute ischemic stroke patients presenting with large vessel occlusion. The acquisition of this information does not require any extra time or processing and may greatly assist in the selection of patients who are potential candidates for endovascular treatment.
O-005 Solitaire FR stent used as a revascularization device in acute ischemic stroke. Acute results: Montpellier preliminary experience
Authors: Machi P , Costalat V , Riquelme C , Maldonado I , Bonafé A 
Published: December 2010

Background and purposePrompt recanalization of occluded brain arteries in patient victims of acute ischemic stroke (AIS) is associated with a better clinical outcome. Several trials have assessed the efficacy and safety of intra-arterial (IA) mechanical thrombectomy combined with intravenous (IV) administration of thrombolytic drugs in the therapy of AIS. The aim of this work is to evaluate the efficacy and the safety of Solitaire FR (SFR) (ev3 Inc, Irvine, California, USA) as a revascularization device in the treatment of AIS in combination with IV administration of thrombolytic drugs.Materials and methodsData of 21 patients treated with SFR within 7 h of AIS symptom onset in the setting of a prospectively defined IV–IA combined therapy were analyzed.ResultsSFR was successful to achieving complete recanalization in 19 patients (90.4%) with a final score of 3 according to the Thrombolysis in Myocardial Infarction (TIMI) classification. Partial recanalization (TIMI2) was obtained in one patient (4.7%). Treatment failure was observed (TIMI0) in one patient (4.7%).Four adverse events were recorded (21%): two intraprocedural thromboembolic events (10.5%) and two symptomatic intracranial hemorrhagic infarctions (10.5%). One patient died during the hospitalization due to massive brainstem infarction.Marked improvement of National Institutes of Health Stroke Scale from baseline to 24 h after recanalization was obtained in 12 patients (57.1%).ConclusionsSFR was effective in achieving a high rate of complete artery recanalization with a low rate of complications. SFR may be considered as a promising tool for endovascular cerebral thrombectomy.
O-006 A novel microcatheter based device for endovascular mechanical thrombectomy/flow restoration
Authors: Tateshima S , Zauner A , Barr J , Lopes D , Liebeskind D 
Published: December 2010

PurposeTo evaluate the performance of a new microcatheter based device (ReStore, Reverse Medical, Irvine, California, USA) for endovascular mechanical thrombectomy/flow restoration in a swine thromboembolic model and to compare its efficacy over other available devices for mechanical thromboembolectomy.MethodWe investigated the use of ReStore for thrombectomy treatment against similar control devices. The cerebral vasculature swine model was utilized in which 12 of each carotid artery branches were prepared with prophylactic papaverine due to the vasospastic nature of the swine model and occluded with radio-opacified blood thrombi. The thrombi were prepared in such a way to represent characteristics of those found in acute stroke patients. The thrombi were injected into target arteries via a 6 Fr guiding catheter. The thrombi were allowed to set up in situ for at least 15 min until complete localized occlusion of the target vessels were confirmed by angiography. Once the occlusion was confirmed, ReStore or a control device was advanced via a 6 Fr guide catheter and precisely positioned across the target thrombi over a microguide wire. No flow arresting means was utilized during retrieval or recanalization attempts. Only localized aspiration was conducted via the 6 Fr guide catheter, once the ReStore or control device holding retrieved thrombi was pulled down to the tip of the guide catheter. Parameters collected for this assessment study were TIMI score, number of retrieval attempts, per cent clot retrieved, time to recanalization, thrombus fragmentation and loss of thrombus at the tip of the guide catheter.ResultsWe found higher TIMI scores (OR 9; 95% CI 0.28 to 285.3), recanalization on the first attempt (9/10 vs 0/2; p<0.01) and per cent clot retrieved (74% vs 20%; p=0.06) with ReStore over the control devices while procedure times for ReStore appeared to be the same as that of the control device. Despite the use of prophylactic papaverine, vasospasm was still prevalent in all cases, even during guidewire and catheter manipulations. No vessel dissections or device failures were encountered during this study. Study recanalization rates for ReStore (9/10, 90%) in the swine model, which is much less tortuous than humans, and the radio-opacified thrombi allowed for more accurate target positioning and retrieval.ConclusionReStore is effective in removal of thrombi and recanalization of blood flow within the swine cranial arteries.Abstract O-006 Figure 1