bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-006 Intraprocedural flat panel perfusion scan-immediate reversal of deficit after MCA thrombectomy
Authors: Moser F , Maya M , Moore T , Song S , Pressman B 
Published: July 2012

PurposeFlat Panel Detector CT (FPCT) has shown promise as a tool in treating and assessing acute stroke treatment.1–3We have begun are organized study to compare this modality to standard multislice CT perfusion studies and see if reversal of prediction of outcomes can be derived from these intraprocedural studies. We are reporting our initial experience.CaseA 58-year-old male was transferred to our institution after being given intravenous t-PA for an acute left middle artery stroke. On admission he was nearly completely recovered from his event with a CTA demonstrating a defect in the left distal M1 segment. On hospital day 2 he developed a profound left-sided weakness. A MSCT perfusion showed a large perfusion deficit in the right MCA territory with an occlusion of the artery on the CTA. He was brought to the angiographic suite and was entered into an IRB approved post marketing study of FPCT perfusion. He underwent an aortic run with the catheter in the very proximal aorta before (Abstract E-006 figure 1) and after (Abstract E-006 figure 2) successful thrombectomy with a 054 Penumbra System.Abstract E-006 Figure 1Abstract E-006 Figure 2ResultsThe FPCT perfusion study demonstrated immediate reversal of the perfusion deficit and the patient recovered. We will present the studies.ConclusionAlthough this is an initial case there was a dramatic change in the perfusion scan and rapid clinical improvement. The study is ongoing.Competing interestsF Moser: None. M Maya: None. T Moore: Siemens Medical Solutions. S Song: None. B Pressman: None.References1.Struffert T, Deuerling-Zheng Y, Kloska S,et al.Flat panel detector CT in the evaluation of brain parenchyma, intracranial vasculature, and cerebral blood volume: a pilot study in patients with acute symptoms of cerebral ischemia.AJNR Am J Neuroradiol2010;31:1462–9.2.Struffert T, Deuerling-Zheng Y, Engelhorn T,et al.Feasibility of Cerebral Blood Volume Mapping by Flat Panel Detector CT in the Angiography Suite: First Experience in Patients with Acute Middle Cerebral Artery Occlusions. 10.3174/ajnr.A2839.3.Mordasini P, El-Koussy M, Brekenfeld C,et al.Applicability of tableside flat panel detector CT parenchymal cerebral blood volume measurement in neurovascular interventions: preliminary clinical experience.AJNR2012;33:154–8.
E-063 Endovascular treatment of fusiform intracranial vertebral artery aneurysms using reconstructive techniques: single center experience
Authors: Dabus G , Samaniego E , Linfante I 
Published: July 2012

ObjectiveFusiform intracranial aneurysms are challenging lesions that occur secondary to atherosclerosis or dissection. Although unclear, the prognosis of patients with fusiform aneurysms seems to be poor. We report our single center experience in the treatment of fusiform aneurysms involving the intracranial vertebral arteries using reconstructive endovascular techniques.MethodThe neurointerventional database of our institution was retrospectively reviewed from June of 2010 to February of 2012. Patients who underwent endovascular treatment of fusiform intracranial vertebral artery aneurysms using reconstructive techniques were included in the analysis. Patients treated with parent vessel sacrifice (deconstructive technique) were excluded. Clinical presentation, size, reconstructive technique used, procedural complication, clinical and angiographic follow-ups were included in the analysis.ResultsSeven patients met the inclusion criteria in our study. There were four men and three women with a mean age of 56 years (range 41–76 years). Two patients (two women) presented with acute subarachnoid hemorrhage (SAH) and were treated with stent assisted coil embolization (SACE). Five patients had unruptured aneurysms; four patients were treated with SACE; the other patient had a partially thrombosed aneurysm and was treated with stent-reconstruction with deployment of two stents (no coiling). The mean of the largest diameter of the lesions was 8.7 mm. There was one asymptomatic procedural complication (non-flow-limiting cervical dissection). All patients had good clinical outcomes (mRS <2) with no late hemorrhage at a mean clinical follow-up of 12 months. One patient that presented with SAH was lost to angiographic follow-up; for all other six patients angiographic follow-up was obtained (mean of 9.6 months). Of these patients, five demonstrated aneurysm occlusion with complete vessel reconstruction in the follow-up. One patient that presented with SAH and was treated with SACE had aneurysm regrowth at 1 month and was retreated with further coil embolization and deployment of a 3rd stent with no complications.ConclusionsThe use of reconstructive techniques in the endovascular treatment of unruptured fusiform intracranial vertebral artery aneurysms is feasible, safe and effective in the mid-term. In patients presenting with SAH, however, the safety and effectiveness of these techniques remain unclear.Competing interestsG Dabus: Codman Neurovascular. Surpass Medical. E Samaniego: None. I Linfante: Codman Neurovascular. Surpass Medical.
E-064 Endovascular treatment of acute vertebro-basilar occlusion with self-expandable stents: single center experience
Authors: Dabus G , Samaniego E , Linfante I 
Published: July 2012

ObjectiveThe rate of death or disability associated with acute basilar artery occlusion (BAO) is as high as 80%–90% with standard medical therapy. We report our single center experience in the treatment of acute BAO with self-expandable stents (SES).MethodThe stroke database of our institution was retrospectively reviewed from June of 2008 to February of 2012. Patients with angiographic evidence of symptomatic BAO in whom SES were attempted to deploy as acute endovascular intervention were included in the analysis. Good outcome was defined as a modified Rankin Scale ≤2 on follow-up.ResultsTen patients with acute BAO in whom stents were attempted to deploy were identified. Median National Institute of Health Stroke Scale score on admission was 18. The average of time from symptom onset to endovascular treatment was 11 h after any vertebro-basilar ischemic symptoms had started. Pre-procedure, all patients had a TIMI score of 0. Stents were successfully deployed in 90% (9/10) of cases. One stent was not deployed due to severe vessel tortuosity. Twelve stents were deployed in nine subjects. Seven out of 10 patients (70%) had a TIMI score of 3 at the end of the procedure. The rate of procedural complications was 20% (2/10). Two patients developed intracerebral hemorrhage due to wire perforations. Fifty percent patients (5/10) achieved good outcome (mRS ≤2) on follow-up. Four patients died and one had severe disability.ConclusionsThe use of SES in this small cohort of patients with acute BAO is technically feasible with high recanalization rates. The safety and efficacy of the procedure need to be addressed in larger randomized controlled study.Competing interestsG Dabus: Codman Neurovascular. Surpass Medical. E Samaniego: None. I Linfante: Codman Neurovascular. Surpass Medical.
E-065 Diagnosis and management of intracranial hypotension: a case review: Abstract E-065 Figure 1
Authors: Bourgeois A , Kvamme P , Chang T , Laing G 
Published: July 2012

PurposeHeadache remains one of the top three most common indications for neurologic imaging. Intracranial hypotension is one causative etiology of headache, which although rare, carries considerable morbidity and potential mortality. Initial misdiagnosis is very common despite the presence of a unique and well-defined constellation of imaging findings. This case-based review examines the mechanisms of pathogenesis, common clinical features, and imaging findings associated with seven recent cases of intracranial hypotension. Interventional management of symptomatic intracranial hypotension includes epidural blood patching, percutaneous placement of fibrin sealant, and surgical CSF leak repair. However, outcomes and treatment strategies remain poorly studied. This review also discusses various treatment strategies utilizing our own experience, in order to better manage intracranial hypotension.MethodsFollowing IRB approval, a retrospective chart review was performed from the time period of January 1, 2009–October 1, 2011. Symptomatic patients with low intracranial pressures (<15 cm H2O) as demonstrated by lumbar puncture and with correlating cross sectional imaging within 1 month of the diagnostic lumbar puncture were included.ResultsEach of the seven patients displayed at least one classic imaging feature of intracranial hypotension:Downward displacement of the brain through the incisura or “slumping of the midbrain”.Diffuse dural thickening and enhancement.Venous and dural sinus distension.Subdural hygromas/hematomas.Perineural root sleeve cysts.Epidural contrast collections.Flaring or other bizarre root sleeve morphology.Abnormal nerve root morphology and epidural fluid/contrast collections were the most common imaging abnormalities. CT guided percutaneous, multilevel epidural patching using own blood or synthetic patch material were utilized for treatment. Five of the seven patients required a repeat procedure.ConclusionRecognition of the common findings of intracranial hypotension is important as this diagnosis is often not considered, potentially leading to more invasive and ineffective therapies. When detected, successful treatment can be achieved utilizing several techniques although repeat treatments are often necessary.Competing interestsNone.References1.Rabin,Barry,et al.Spontaneous intracranial hypotension: spinal MR findings.Am J Neuroradiol1998;19:1034–9.2.Farb RJ,et al.The venous distension sign: a diagnostic sign of intracranial hypotension at MR imaging of the brain.AJNR Am J Neuroradiol2007;28:1489–93.3.Schievink,Wouter. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.JAMA2006;295:2286–96.4.Schievink,Wouter,et al.Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension.Am J Neuroradiol2008;29:853–6.Abstract E-065 Figure 1
E-066 A favorable profile for selecting acute ischemic stroke patients for thrombolytic therapy: Abstract E-066 Table 1
Authors: Moradzadeh N , Sharma J , Vargas E , Jung R , Koo B , Blackham K 
Published: July 2012

BackgroundThere is currently an intense interest in defining predictive profiles from MRI based diffusion/perfusion information for acute ischemic stroke patients. Perfusion/diffusion ratio (mismatch ratio) and penumbra volumes are factors used to select patients for thrombolysis. The current literature considers a mismatch ratio of 1.2 as the minimum for thrombolysis. There is much debate, however, as to how mismatch ratios and penumbra volumes affect patient outcome.Methods31 acute ischemic stroke patients were selected at random and had their presenting acute stroke-protocol MRI processed through OLEA Medical's PerfScape, which calculated the penumbral volume and mismatch ratio, using a Tmax of 4 s. A mismatch ratio of 1.2–4.5 with a penumbra volume >80 cc was labeled as a Favorable Profile (FP). NIHSS scores were collected both at stroke presentation and at time of discharge. An improvement of NIHSS ≥4 at time of discharge was considered a good outcome.ResultsEight patients were found to have a FP with a mismatch ratio between 1.2 and 4.5 and a penumbra volume >80 cc. Twenty-three patients did not have an FP. Of the eight patients with an FP, all 8 had an improvement of ≥4 in their NIHSS score. Of the 23 patients who did not have an FP, 7 had an improvement of ≥4 in their NIHSS score, while 16 had no improvement or an improvement of <4 in their NIHSS score, (p=0.0008). Furthermore, a homogenous subset of patients (N=20) who underwent thrombolytic therapy and achieved TIMI 2 or greater recanalization, showed similar findings (p=0.02)ConclusionThis small study demonstrates that our definition of a favorable MRI perfusion profile in ischemic stroke patients (mismatch ratio of 1.2–4.5 and a penumbra volume >80 cc) was associated with a good outcome at discharge, for all patients as well as an endovascularly treated homogeneous subset. Furthermore, the clinical application of this upper limit of 4.5 for the mismatch ratio warrants further investigation.Abstract E-066 Table 1Favorable profile and NIHSS improvementNIHSS improvement ≥4NIHSS improvement <4Favorable Profile (Mismatch ratio of 1.2–4.5 and penumbra volume >80 cc)80Not a Favorable Profile716Competing interestsNone.
E-068 CT angiography in the diagnosis of non-aneurysmal spontaneous subarachnoid hemorrhage: a meta-analysis
Authors: Jethwa P , Punia V , Gandhi C , Prestigiacomo C 
Published: July 2012

IntroductionModern CT angiography (CTA) has shown high sensitivity for detecting a ruptured aneurysm in the setting of acute subarachnoid hemorrhage (SAH). Patients with SAH and no aneurysm found on CTA pose a diagnostic dilemma for treating physicians. These patients traditionally undergo digital subtraction angiography (DSA) in search of an occult aneurysm; however, this practice has recently been called into question. We performed a meta-analysis of the current literature to assess the role of CTA in the diagnosis of non-aneurysmal SAH (NASAH).MethodsA systematic review of the literature was performed to find articles comparing the sensitivity of CTA to DSA for diagnosing aneurysms in the setting of acute SAH. Based on clinical relevance, only studies performed with 16-slice CT scanners or greater were included in the analysis. Data from these studies were combined with our own institutional data to create an overall 2×2 table, from which descriptive statistics were generated.ResultsAfter an extensive literature review, 22 studies were included in the final analysis. The total number of true positive, false positive, true negative, and false negative CT angiograms were 3046, 7, 737, and 33, respectively. The overall sensitivity and specificity were 98.9% (98.4–99.2) and 99.1% (98.0–99), respectively. The positive and negative predictive values were 99.8% (99.5–99.9) and 95.7% (94.0–97.0), respectively. There was a trend toward higher sensitivity with 32- and 64-slice CT scanners when compared with 16-slice scanners, but this difference was not statistically significant.ConclusionsThe results of this analysis demonstrate the high sensitivity of 16-slice or greater CTA in detecting aneurysms in acute SAH. Therefore, the vast majority of patients with negative CTA requires no further workup and needs not be subjected to the risks of DSA. DSA should be reserved only for patients exhibiting a clinical exam incongruent with NASAH, which has a typically benign course.Competing interestsNone.
E-007 Urgent recanalization with stent for severe intracranial stenosis in patients with transient ischemic attack or minor stroke
Authors: Lee T , Song S , Lee S 
Published: July 2012

Background and purposeStenting of symptomatic intracranial stenosis has recently become an alternative treatment modality. However, urgent intracranial stenting in patients with intracranial stenosis following a transient ischemic attack (TIA) or minor stroke is open to dispute. We sought to assess the feasibility, safety, and effectiveness of urgent intracranial stenting for severe stenosis (>70%) in TIA or minor stroke patients.MethodsBetween June 2009 and November 2011, stent-assisted angioplasty by using stent for intracranial severe stenosis (>70%) was performed in nine patients after TIA (12 stenotic lesions) and 19 patients after minor stroke (21 stenotic lesions). Technical success rates, complications, angiographic findings, and clinical outcomes were retrospectively analyzed.ResultsStenting was successful in all 28 patients. The mean time interval from stroke symptom onset to stenting was 4.2 days (1∼13 days). The mean pre-procedural stenosis was 83.3% (range 70%–95%), and the mean stenosis immediately after stent placement was 4.2%. In-stent thrombosis occurred in three lesions (n=3, 9.1%), and was lysed with abciximab. Procedure-related asymptomatic dissection occurred in one lesion (n=1, 3.0%), and was solved by implanting a second stent. No intracranial hemorrhage or vessel perforation occurred in any patient. During the mean follow-up period of 14.4 months (range, 2–31 months), one patient had a symptomatic in-stent restenosis (80%) after 6 months of stent placement.ConclusionUrgent recanalization with stenting is feasible, safe, and effective in patients with TIA or acute minor stroke with intracranial stenosis of ≥70%.Competing interestsNone.
E-071 CT perfusion as a tool to predict the risk of hemorrhagic transformation in ischemic stroke treated with tissue plasminogen activator: a single center experience
Authors: Kass-Hout T , Kass-Hout O , Al Masry M , Mokin M , Wack D , Nourollahzadeh E , Siddiqui A , Levy E , Synder K 
Published: July 2012

ObjectiveTo use the CT Perfusion (CTP) parameters at the time of hospital admission, including Cerebral Blood Volume and Permeability Surface area product (PS), to identify patients with higher risk to develop hemorrhagic transformation in the setting of acute stroke therapy with intravenous thrombolysis.MethodsRetrospective study that compared admission CTP variables between patients with Hemorrhagic Transformation (HT) acute stroke and those with no hemorrhagic transformation. Both groups received standard of care intravenous thrombolysis with tPA. Twenty patients presented to our stroke center between the years 2007 and 2011 within 3 h after stroke symptoms onset. All patients underwent two-phase 320 slice CTP which creates Cerebral Blood Volume and PS measurements. Patients were divided into two groups according to whether or not they had HT on a follow-up CT head without contrast, done within 36 h of the thrombolysis therapy. Clinical, demographic and CTP variables were compared between the HT and non-HT groups using logistic regression analyses.ResultsHT developed in 8 (40%) patients. Patients with HT had lower ASPECT score (p=0.03), higher NIHSS on admission (p=0.01) and worse outcome (p=0.04) compared to patients who did not develop HT. Baseline blood flow defects were comparable between the two groups. The mean PS for the HT group was 0.53 ml/min/100 g brain tissue, which was significantly higher than that for the non-HT group of 0.04 ml/min/100 g brain tissue (p<0.0001). The mean area under the curve was 0.92 (95% CI). The PS threshold of 0.26 ml/min/100 g brain tissue had a sensitivity of 80% and a specificity of 92% for detecting patients with high risk of hemorrhagic transformation after intravenous thrombolysis.ConclusionsAdmission CTP measurements might be useful to predict patients who are at higher risk to develop hemorrhagic transformation after acute ischemic stroke therapy.Competing interestsT Kass-Hout: Genentech. O Kass-Hout: None. M Al Masry: None. M Mokin: None. D Wack: None. E Nourollahzadeh: None. A Siddiqui: NINDS 1R01NS064592-01A1, University at Buffalo. Shurtleff, Inc, Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra. Codman & Shurtleff, Inc, Genentech. Hotspur, Intratech Medical, StimSox, Valor Medical. Abbott Vascular, American Association of Neurological Surgeons, Neocure Group LLC, an Emergency Medicine Conference. E Levy: Codman & Shurtleff, Inc, ev3/Covidien Vascular Therapies, Boston Scientific. TheraSyn Sensors, Inc. Medical Ltd., Mynx/Access Closure. Boston Scientific. K Synder: Toshiba and ev3.
E-076 Imaging to endovascular recanalization in less than an hour is feasible
Authors: Almekhlafi M , Eesa M , Menon B , Demchuk A , Goyal M 
Published: July 2012

IntroductionThe shorter the time from core estimation by imaging to recanalization, the more likely that core expansion is minimized. We aimed to assess the feasibility of achieving an ultra-short imaging to recanalization time in the routine practice setting.MethodsThis is a prospective, single-operator, case series of acute ischemic stroke patients treated with endovascular therapy in a tertiary center where imaging to recanalization of <60 min was achieved.ResultsImaging to recanalization time <60 min was accomplished in 38% (11 patients) of treated patients. The median imaging to recanalization time was 47 min. The median 24-h NIHSS scale was 1 (range 0–11). Upon discharge, 82% of patients achieved a modified Rankin scale score of 1 or less.ConclusionsAn imaging to recanalization time under 60 min is feasible and may be associated with better functional outcome.Competing interestsNone.
E-078 Acute stroke intervention with solitaire stent: a meta-analysis
Authors: Dumont T , Kass-Hout T , Eller J , Siddiqui A , Levy E 
Published: July 2012

IntroductionBased on promising revascularization results in the SWIFT trial (83% revascularization), FDA approval of the Solitaire stent for acute stroke intervention is anticipated. The Solitaire stent has been used extensively in Europe for acute stroke intervention. This important real-world use case experience provides insight into the applicability of Solitaire for post-market use. The purpose of this study is to review existing case series of stroke intervention with Solitaire to evaluate efficacy in revascularization and outcomes.MethodA meta-analysis of existing case series with acute stroke intervention employing the Solitaire stent was performed. Case series were identified using a thorough literature review. All case series (including case reports) were included. Endpoints including recanalization and Modified Rankin Score on discharge were noted.ResultsTwelve studies were identified with at least one acute stroke intervention with the Solitaire stent. These studies included a total of 205 patients. Revascularization was successfully performed in 182 patients (89%). Acceptable outcomes (MRS 0–2) were reported for 100 patients (49%).ConclusionsWith the anticipated approval of the Solitaire stent for publication of the SWIFT trial in a few months, “real world” case series such as this will soon be of less relevance. In itself, this relatively small series has little to offer in comparison to the similar reports cited. In addition, several more similar case series have been published since the writing of this manuscript (by my count at least seven more series are available on PubMed). At the very least, these articles should be considered in a revision prior to re-submission.Competing interestsT Dumont: None. T Kass-Hout: None. J Eller: None. A Siddiqui: Grants: University at Buffalo, National Institutes of Health (not for this study). Codman & Shurtleff, Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra;. Financial interests: Hotspur, Intratech Medical, StimSox, Valor Medical; Speakers' Bureaus: Codman & Shurtleff, Genentech; Honoraria: Abbott Vascular, Genentech, Neocure Group, Annual Peripheral Angi. E Levy: Grant, other research support, research support: Codman & Shurtleff, Inc., ev3/Covidien Vascular Therapies. consultant/advisory board: Codman & Shurtleff, Inc.; Consultant per project and/or per hour: Codman & Shurtleff; ev3/Covidien Vascular Therapies, TheraSyn Sensors. ownership interests: Intratech Medical, Mynx/Access Closure; honoraria: Boston Scientific; fees for carotid stent training: Abbott Vascular, ev3/Covidien Vascular Therapies. Receives no consulting salary.