bluuebunny/crossref_metadata_2025_split huggingface dataset:
O-034 Mobile phone-based remote patient information system for management and therapy in acute stroke patients: The i-stroke system
Authors: Takao H , Murayama Y , Ishibashi T , Yuki I , Karagiozov K , Abe T 
Published: July 2012

PurposePhysicians must quickly evaluate stroke patients to determine if they're eligible for time-sensitive treatment and prompt diagnosis and treatment of cerebral stroke patients are essential to their recovery. With the increasing demand for such management of stroke, telemedicine's role of coordinating timely the efforts of a stroke team became important. We developed “i-Stroke” system in Japan to access rapidly diagnostic images and clinical information.MethodsThis system was made on the basis of transferring patient data, images and movie (Angio and/or Operating room) between hospital systems and participating medical staffs in and out of the hospital, through their standard, currently utilized mobile devices (iPhone, Andorid). The system is able to transfer clinical data, CT, MR, echo, angiographic and intraoperative images and expert opinion in real time. It provides also tools for management of diagnostic and treatment information, even such as simple calculation of appropriate drug dosage, modified Rankin Scale and perfusion diffusion mismatch.ResultsA pilot application of the system in our hospital showed adequate performance and proper information transfer, resulting in proper diagnosis and management of all stroke patients. The i-Stroke system was introduced at our institution in August 2010, for communication with our affiliated hospitals and over 100 “i-stroke” call were initiated until the end of February 2012.ConclusionsThe “i-stroke” system proved to be efficient for appropriate standard management in most time demanding treatments of stroke. It is our belief that adoption of this software with handheld terminals will make it possible to help and save the lives of more patients who suffer cerebral stroke.Competing interestsH Takao: FUJIFILM Co. Ltd. Y Murayama: FUJIFILM Co. Ltd. T Ishibashi: None. I Yuki: None. K Karagiozov: None. T Abe: None.Abstract O-034 Figure 1Abstract O-034 Figure 2
P-013 Treatment of ruptured basilar artery pontine perforator aneurysm with neuroform stent monotherapy: a report of two cases: Abstract P-013 Figure 1
Authors: Turner R , Turk A , Chaudry I , Nyberg E , Spiotta A , Fiorella D 
Published: July 2012

IntroductionSubarachnoid hemorrhages (SAH) are most commonly caused by trauma, ruptured cerebral aneurysm, and benign perimesencephalic hemorrhage. We report two cases of basal cistern SAH that were initially angiographically negative, however follow-up delayed angiography demonstrated an 2 mm aneurysm arising from a sub-millimeter pontine artery perforator, distinct from the basilar artery. In each case, treatment was placement of two overlapping Neuroform stents in the basilar artery.Case presentationA 46-year-old man presents with SAH centered in the pre-pontine cistern. Initial angiography was negative and the patient clinically did well, however subsequent angiography at 6 weeks demonstrated a 2 mm aneurysm arising from a pontine artery perforator. A 61-year-old female presented to with a SAH. Similarly, the initial angiography was negative, however subsequent angiography demonstrated a 2 mm aneurysm arising from a pontine artery perforator.DiscussionIn both cases, the patients' aneurysm originated from a small pontine artery perforator and the basilar artery was clearly distinct. In the first case (in 2006) had treatment options of observation, surgical exploration, or stenting of the basilar artery. The perforator was too small to catheterize with a microcatheter. Placement of overlapping Neuroform stents did not change aneurysm opacification initially, however at follow-up angiography, the aneurysm no longer opacified despite the artery being patent (Abstract P-013 figure 1A). The second case occurred in 2011, and therefore flow diversion with Pipeline was possible, however we chose to place overlapping Neuroform stents, which resulted aneurysm occlusion while maintaining vessel potency (Abstract P-013 figure 1B).Abstract P-013 Figure 1ConclusionAneurysms arising from a basilar artery perforator are extremely rare, however successful treatment is possible. Although we treated with conventional microstents, newer flow diversion devices also offer a reasonable treatment option.Competing interestsR Turner: Microvention, Codman. ev3, Penumbra, Mindframe. A Turk: None. I Chaudry: None. E Nyberg: None. A Spiotta: None. D Fiorella: None.
P-021 A randomized trial comparing platinum and hydrogel-coated coils in patients prone to recurrence after endovascular treatment—the PRET trial: Abstract P-021 Figure 1
Authors: Raymond J , Roy D , Weill A 
Published: July 2012

PurposeThe PRET trial aims compares hydrocoils to bare platinum coils in patients with aneurysms prone to recurrence, that is, in patients with large aneurysms (≥10 mm; PRET-1 patients) or in patients with a major recurrence after previous coiling (PRET-2 patients). We aim at reporting an update of the randomization rate and results of the interim analysis from the DMSC.Materials and MethodsPRET is a RCT with single-blind allocation. 500 subjects are followed for 18 months. PRET-1 (250) and PRET-2 (250) cases are randomized separately. Interventions are : a/bare coil embolization, or b/hydrocoil embolization. Primary endpoint is recurrence rate. Secondary endpoints include procedural complications, clinical outcome, safety of hydrogel coiling and overall M&M.Results344 PRET subjects were randomized by 33 sites in Canada, US, France, UK, Japan and Chile. Baseline characteristics of the first 264 PRET subjects were (mean (SD)): Age = 59 (11) years; 73% had only one aneurysm; 16% presented with acute rupture of the aneurysm; Aneurysm parameters for PRET1 subjects (53%) were: size = 14 (5) mm and in 57% of cases located in the anterior circulation. Aneurysm parameters for PRET2 subjects (47%) were: size = 13 (11) mm and in 57% of cases located in the anterior circulation. An interim safety analyses carried out on 234 subjects did not reveal any significant difference in SAEs or clinical outcome (mRS>2 at discharge and 1-month follow-up) between treatment arms.ConclusionWe hope that PRET will show that for the treatment of aneurysms prone to recurrence, Hydrocoils provide an equal or higher efficacy than bare platinum coils with no difference in safety profile.Competing interestsJ Raymond: Microvention Inc. (investigator-led clinical trial funding for PRET). D Roy: None. A Weill: None.Abstract P-021 Figure 1
P-028 Clinical experience and lessons learned with the penumbra PC 400 large volume coil: improving the treatment of both large and small aneurysms
Authors: Baxter B , Quarfordt S 
Published: July 2012

ObjectiveWe report our clinical experience in treating 34 aneurysms in 29 patients using the Penumbra PC400 Large Volume Coil.Clinical presentation and treatmentOur treatment population consisted of four large (10–25 mm) and 30 small (<10 mm) aneurysms. Nine were ruptured and 25 unruptured. Aneurysm location was 24 anterior circulation vs 10 posterior circulation. For the small aneurysms the average aneurysm size was 5.4 mm, average of 2.1 coils/aneurysm, and 48.9% average packing density. For the large aneurysms the average aneurysm size was 11.5 mm and 31.2% average packing density. An average of 5.6 coils were placed in three of the large aneurysms that were treated with only the PC400 coils. One of the large aneurysms had been previously treated with five GDC coils and then three Penumbra coils were used to treat recurrent aneurysm. Two patients had a stent placed across the aneurysm neck during a separate procedure performed prior to coiling and two patients had a stent placed during the coil procedure. One patient with a ruptured Left SCA aneurysm experienced a non-disabling Left PCA infarct giving a 2.9 % complication rate. Six month follow-up performed in 14 aneurysms.ConclusionOur clinical experience with the PC400 Coil system has demonstrated this 0.020′ coil and 025 ID deployment catheter to be safe and efficacious in treating both small and large aneurysms. Using the PC400 Large Volume Coil results in a higher packing density while using fewer coils. The use of fewer coils has proven to reduce case time and procedural costs. Follow-up data suggest that the use of the coils produced durable occlusions. The softness by design of this large volume coil combined with the improved body of the deployment catheter has markedly improved the treatment of both large and small aneurysms.Competing interestsB Baxter: Stryker, ev3.
P-031 Mechanical thrombectomy with the solitaire device: is there a learning curve toward achieving rapid recanalization times?: Abstract P-031 Figure 1
Authors: Eesa M , Almekhlafi M , Menon B , Wong J , Demchuk A , Goyal M 
Published: July 2012

Introduction/PurposeWe evaluated recanalization times with the Solitaire device in patients undergoing endovascular acute ischemic stroke therapy at our institution.Materials and MethodsWe reviewed patients who presented to our stroke center and in whom a Solitaire device was used for revascularization. Demographic data and stroke severity were obtained from chart review. Time points for CT scanning, angiography arrival, puncture, time of first deployment of the device and recanalization times were recorded from time-stamped PACS images and angiography records. Time intervals were calculated (CT to angiography arrival, angiography arrival to puncture, puncture to first deployment and deployment to recanalization). To evaluate time interval trends, recanalized patients were sequentially divided into three sequential groups. Overall CT to recanalization time and interval times between groups were compared using an analysis-of-variance (ANOVA) test. In addition, we also looked for difference between groups using the Scheffe's test correcting for multiple comparisons. All tests are two sided with a p value <0.05 considered to be statistically significant. Analysis was performed using Stata® V.12.Results83 patients (38 female; mean age: 65.7±14.3) were treated with the Solitaire device from May 2009 to February 2012. The median NIHSS was 17. Recanalization (TIMI 2/3) occurred in 75 (90.4%) patients. CT to recanalization time showed a statistically significant decrease over time (p<0.01). This difference was maximal between first 25 and most recent 25 cases (161 to 94 min, p<0.01). The maximal contribution to this was from improvements in first deployment to recanalization time between the first 25 and second 25 patients (p=0.01) and between the first and third 25 patients (p=0.001) with modest contributions from moving patients from CT to the angiography-suite faster (p=0.02 between 1st and 3rd groups) and from puncture to first deployment (p=0.02 between 1st and 3rd groups). There was no statistically significant difference in time from angiography-suite arrival to puncture between the groups (Abstract P-031 figure 1).Abstract P-031 Figure 1ConclusionThere appears to be a learning curve involved in the efficient use of the Solitaire device in endovascular acute stroke therapy. Along with slight improvements in moving patients to angiography sooner and improved efficiency with intracranial access, mastering this device contributed significantly toward the overall drive to reduce recanalization times in stroke patients treated by an endovascular approach at our institution. This needs to be validated in a prospective manner to understand components of this learning curve that is potentially useful to educate new users to achieve faster recanalization times.Competing interestsNone.
P-037 Death and disability after coil embolization of ruptured and unruptured aneurysms in the Matrix and Platinum Science (MAPS) trial
Authors: Nesbit G , Johnston S , Gholkar A , Turk A , Hetts S , Mocco J , Imm S , Ge S , McDougall C 
Published: July 2012

Background and PurposeWe sought to evaluate overall rates of disability and mortality in patients treated with coil embolization for unruptured and ruptured intracranial aneurysms who were enrolled in the MAPS trial, a multicenter randomized trial that showed that Matrix2 biocompatible absorbable polymer-coated coils were noninferior to GDC bare-platinum coils.Materials and MethodsWe conducted a randomized trial with blinded outcome assessment performed at 43 centers worldwide. Eligible patients were 18–80 years old with a single documented untreated intracranial saccular aneurysm, 4–20 mm, ruptured or unruptured (Hunt and Hess score I-III, modified Rankin Scale (mRS) score 0–3) for which both Matrix2 and GDC coils were treatment options, and for which primary coiling treatment was planned to be completed during a single procedure. mRS was assessed at baseline and 1 year follow-up, and predictors of disability or mortality (mRS>3) and a worsening in the mRS were evaluated in univariate and multivariable models using logistic regression. The trial was registered athttp://clinicaltrials.govasNCT00396981.ResultsAmong 626 subjects enrolled, 570 had an mRS assessment available at 1 year, of whom 208 initially presented with a ruptured aneurysm and 362 with an unruptured aneurysm. During 1 year follow-up, 24 had died (3.8%), of which 7 (1.1%) were judged device or procedure related by the clinical events committee; another 11 were disabled (1.8%). Rates of death or disability were greater for ruptured aneurysms (9.6%) than for unruptured aneurysms (4.1%, p=0.009); however, rates of worsening in mRS were similar (ruptured 11.7% vs 10.2%, p=0.583). Rates of death and disability were similar for those randomized to GDC compared to Matrix (p=0.601), as were rates of worsening of mRS (p=0.489). Independent predictors of death or disability were older age (per decade, OR 2.1, 95% CI 1.3 to 3.4, p=0.001), current smoker (OR 5.5, 1.9 to 15.5, p=0.0014), diabetes (OR 4.5, 1.4 to 14.6, p=0.012) and current use of illicit drugs or alcohol (OR 3.5, 1.0 to 11.9, p=0.042). Coil type (GDC vs Matrix), other clinical characteristics, aneurysm characteristics, and retreatment were not predictors of death or disability in univariate or multivariate models.ConclusionsCoil embolization of intracranial aneurysms is rarely associated with death or disability, with overall rates generally lower than previously reported. Although older age and initial rupture are known to be associated with worse outcomes, current smoking status, diabetes, and current use of illicit drugs or alcohol were also baseline predictors but requires independent validation from future studies.Competing interestsG Nesbit: None. S Johnston: Boston Scientific/Stryker Neurovascular. A Gholkar: None. A Turk: None. S Hetts: NIH-NIBIB, Stryker Neurovascular. J Mocco: None. S Imm: Stryker Neurovascular. S Ge: Stryker Neurovascular. C McDougall: None.
E-001 Estimation of stent conformity for cerebrovascular stent with patient-specific curved arterial model
Authors: Shobayashi Y , Tateshima S , Tanishita K , Viñuela F 
Published: July 2012

IntroductionClinically, adaptation of an implanted stent to the vessel wall influences the development of problems such as intimal hyperplasia and in-stent-stenosis for intracranial stenting. In particular, for the stenting in a curved vessel, it was indicated that a stent deployed across an artery with angulation exerts a certain longitudinal rebounding cause of vessel straightening. For this reason, it is necessary to investigate stent-artery interaction including stress distribution and vessel deformation due to stent designs within the realistic curved arterial model.Materials and MethodsThe aim of this study is to analyze and evaluate the stress distribution within the stented curved artery using open and closed-cell stent designs. We focused on stent geometries and calculated the differences in stress within the realistic curved artery due to the structure and stent position using deformation analysis with finite element modeling.ResultsThe results have different stress behavior by stent designs and its position within the parent artery. High stress values were obtained in the curved portion and at the proximal section of the parent artery with the area of contact between stent strut and the artery for all models. This behavior could be explained by differences the metal-to-artery ratio on each side of proximal and distal vessel according to stent position. Furthermore, vessel straightening was obtained for curved section with stented artery due to longitudinal rebounding force of the stent. Comparing the distribution of high stress area for stent designs, open-cell stent has lager area of high stresses than closed-cell stent at distal portion. In the other hand, the stress distribution of closed-cell was similar for different stent position.ConclusionFor our simulation, stent behavior such as stress status and vessel deformation was varied by stent design and its position within the curved artery. This numerical method might be effective for designing a better stent specifically for the intracranial stenting and also to select an appropriate stent prior to the actual endovascular procedure.Competing interestsNone.
E-011 Wingspan stent for symptomatic intracranial stenosis: a single center analysis
Authors: Baxter B , Quarfordt S , Hungerford J , Kline A , Maass G , Huang X 
Published: July 2012

BackgroundThe role of Wingspan stent placement for the treatment of symptomatic intracranial stenosis has been greatly questioned in the wake of the SAMMPRIS trial results, which found a disparity between its treatment arms of medical management with Wingspan stenting and medical management alone for stroke or death at 30 days. The 30-day and 1-year probabilities of the primary endpoint of the SAMMPRIS trial (any stroke or death within 30 days or ischemic stroke in the territory of the qualifying artery beyond 30 days) were 5.8% and 12.2% for the medical management arm and 14.7% and 20.0% for the Wingspan arm, respectively.PurposeThe purpose of this real world study was to evaluate patient outcomes at Erlanger Medical Center who received a Wingspan stent and compare to the SAMMPRIS trial results.MethodsThis was a retrospective cohort analysis of Wingspan stent use for symptomatic intracranial stenosis of a major cerebral artery and compared single center Wingspan group outcomes to those reported for medical management alone from the multi-center SAMMPRIS trial. Consistent with SAMMPRIS, the primary endpoint was any stroke or death within 30 days, or ischemic stroke in the territory of the qualifying artery beyond 30 days.ResultsWith a mean follow-up period of 2.1 years, the 30-day and 1-year probabilities of the primary endpoint were both 10.4% (n=42). Patient characteristics associated with higher risks of adverse events included female sex, diabetes mellitus, location of stent placement, and severity of the offending stenosis.ConclusionOutcomes after Wingspan stenting at this single medical center were only inferior to those from the SAMMPRIS medical management arm at 30 days, but not at 1 year. Outcomes at 30 days and 1 year were both lower than those reported from the SAMMPRIS Wingspan arm and seem to be more consistent with those previously published from other Wingspan registries. Unlike the SAMMPRIS trial results, there was no increase in the probability of the primary endpoint between 30 days and 1 year. This real world experience suggests that the role of Wingspan stenting needs further investigation, and continued evaluation of intracranial stenting for symptomatic intracranial stenosis seems worthwhile.Competing interestsB Baxter: Stryker Neurovascular, Penumbra, Codman, EV3, Rapid Medical, Reverse Medical. S Quarfordt: None. J Hungerford: None. A Kline: None. G Maass: None. X Huang: None.
E-012 Urgent intra-arterial thrombectomy for stroke: technical complications
Authors: de Miquel M , Aja L , Mora P , Aixut S , Cardona P , Quesada H , Rubio F , Barranco R 
Published: July 2012

IntroductionSince April 2010, a pilot experience has been set for offering intra-arterial treatment for stroke to a 3.5 million people population. We aim to share our experience from the standpoint of technical complications.Material and MethodsThe review of 122 patients (69 male and 53 female, mean age 65,4 years) show that twelve cases presented technical complications.In four patients, distal emboli to other territories than the occluded vessel were seen. Two of them were not specifically treated and showed a bad outcome, while the other two were successfully treated with good final Rankin Score.Hemorrhage during microcateterization was noted in four patients. Even though the bleeding was controlled with glue or coils, bad outcome was noted in those patients.One patient presented a femoral pseudoaneurysm related to the puncture site, with severe bleeding and other co-morbidity leading to death.Carotid stent issues in tandem lesions were seen in two patients.In one case, the thrombectomy device was let in place (M1) due to impossibility to retrieve it.Some subclinical incidences as balloon rupture (1 case), M1, M2 or M3 vasospasm, easily resolved with intraarterial nimodipine (3 cases) and some degree of vessel dissection without significant caliber reduction (3 cases) were also recorded.Results and ConclusionIn our series, around a ten percent of intraarterial thrombectomy treatments presented procedure related complications. In our opinion, four of them can be attributed to our learning curve, leading to a theoretical complication risk of around a 7% for technical complications.Competing interestsNone.
E-016 Low cost, efficient, highly effective method for therapeutic arterial occlusion of the internal carotid or vertebral artery with flow control
Authors: Heck D 
Published: July 2012

Therapeutic internal carotid or vertebral artery occlusion is occasionally recommended for a variety of cerebrovascular diseases, including giant aneurysms, vessel ruptures, and arteriovenous fistulae. With the removal of detachable balloons from the U.S. market, there is no ideal device to occlude a cerebral vessel rapidly and safely. Intracranial occlusion of cerebral vessels presents challenges of vessel tortuosity, and the possibility of cerebral embolization during the process of occluding the artery. Coils designed for endovascular occlusion of brain aneurysms are often used because they are deliverable in the intracranial circulation. However, these products are not highly effective for this application, expensive, and multiple coils are often needed which leads to a high cost procedure. Further, if no flow control is used during the procedure, the potential for cerebral embolization is real as thrombus begins to form at the site of occlusion. When proximal balloon occlusion is used, there is no way to “test” the occlusion short of deflating the balloon. Here presented are two cases, one in the internal carotid artery and one in the vertebral artery, of therapeutic occlusion using balloon occlusion guide catheters for flow arrest in the internal carotid artery, and flow reversal in the vertebral artery. The first patient is a 49 year old who presented with acute pain and cranial nerve III palsy and a giant right cavernous carotid aneurysm, and the second a 69 year old who presented with hearing loss and balance difficulty and a giant dissecting aneurysm of the left vertebral artery. Intracranial occlusion was achieved in each case with Interlock coils (Boston Scientific), a 0.018″ fibered, detachable coil, and then the vessel occluded proximally with an Amplatzer vascular plug (St. Jude Medical) to ensure cessation of flow prior to occlusion balloon deflation. The total cost of embolics in each case was <3000 dollars. The principles outlined are generalizable to a variety of situations where parent vessel occlusion is the desired treatment.Competing interestsNone.