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Primary manual aspiration thrombectomy (MAT) for acute ischemic stroke: safety, feasibility and outcomes in 112 consecutive patients
Conclusions Primary MAT is an alternative endovascular recanalization technique with reasonable first pass efficacy that will likely improve with technology and experience.
Source: Journal of NeuroInterventional Surgery - December 11, 2014 Category: Neurosurgery Authors: Jankowitz, B., Grandhi, R., Horev, A., Aghaebrahim, A., Jadhav, A., Linares, G., Jovin, T. Tags: Ischemic stroke Source Type: research

Last resort: case of clot translocation in intra-arterial stroke therapy
A patient was taken for emergent intra-arterial stroke therapy for an acute left middle cerebral artery stroke syndrome, with CT angiography showing a left internal carotid artery (ICA) occlusion. Through a 6 F Neuron MAX sheath, a 5 Max ACE Penumbra aspiration catheter was advanced to the thrombus and direct suction was performed through the ACE catheter and Neuron MAX sheath. Upon pull back, the thrombus became wedged in the Neuron MAX sheath and despite several attempts to aspirate the thrombus, no clot could be obtained. The Neuron MAX sheath was withdrawn to the left common carotid artery, and gently advanced to the o...
Source: Journal of NeuroInterventional Surgery - November 7, 2014 Category: Neurosurgery Authors: John, S., Burgess, R., Cheng-Ching, E., Wisco, D., Taqui, A., Bain, M., Toth, G., Uchino, K., Hui, F., Hussain, M. S. Tags: Electronic pages Source Type: research

Best articles published in 2014 in Journal of NeuroInterventional Surgery
This article describes a novel method for mechanical revascularization using a large bore aspiration catheter. The operators utilized the largest caliber aspiration catheter that the target vessel would accommodate. The catheter was then advanced to the face of the thrombus and aspiration applied. The catheter was subsequently withdrawn, attempting to remove the clot en bloc....
Source: Journal of NeuroInterventional Surgery - November 7, 2014 Category: Neurosurgery Authors: Linfante, I., Mack, W., Chen, M., Rai, A., Albuquerque, F., Gupta, R., Hirsch, J. A., Mocco, J., Fiorella, D., Tarr, R. Tags: Commentary Source Type: research

Delayed ischemic stroke following spontaneous thrombosis of an arteriovenous malformation
We present a unique case of a middle-aged patient with spontaneous obliteration of a cerebral arteriovenous malformation (AVM) who developed an ischemic stroke due to thrombosis of the stagnant proximal segment of the inferior branch of the middle cerebral artery feeder. Although the pathophysiology is not well understood, the arterial feeder hemodynamic changes post SOAVM may behave similarly to what occurs in rare cases after surgical resection of AVMs. Our case raises the hypothesis that stagnation of flow in spontaneous AVM obliteration may lead to delayed ischemic stroke in the territory of the feeding artery.
Source: Journal of NeuroInterventional Surgery - September 5, 2014 Category: Neurosurgery Authors: Shah, A. H., Haussen, D. C., Snelling, B. M., Heros, R. C., Yavagal, D. R. Tags: Electronic pages Source Type: research

Early results of the Axium MicroFX for Endovascular Repair of IntraCranial Aneurysm (AMERICA) study: a multicenter prospective observational registry
Conclusions This prospective study of Axium MicroFX coils demonstrates excellent aneurysm occlusion rates. 52% of aneurysms were completely occluded post-procedure. Within the ruptured aneurysm group, post-procedure occlusion rates were 63.6%. Major AE rates were consistent with historical data.
Source: Journal of NeuroInterventional Surgery - August 6, 2014 Category: Neurosurgery Authors: Fargen, K. M., Blackburn, S., Carpenter, J. S., Jabbour, P., Mack, W. J., Rai, A. T., Siddiqui, A. H., Turner, R. D., Mocco, J. Tags: Hemorrhagic stroke Source Type: research

E-006 Familial Incidence of the Congenital Torcular Dural Arteriovenous Shunt
Purpose There are several hereditary disorders that are well known to be associated with arteriovenous malformations (AVMs) involving the central nervous system including Sturge-Weber, Klippel-Trenaunay-Weber, and Parkes-Weber syndromes as well as hereditary haemorrhagic telangiectasia and hereditary neurocutaneous angiomatosis. Furthermore, familial incidence of AVMs in the absence of congenital hereditary disorders also has been reported. Herein, we describe the occurrence of the giant torcular herophili (TH) dural arteriovenous fistula (AVF) in two pediatric cousins treated with endovascular embolization. Case report C...
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Honarmand, A., Hurley, M., Daruwalla, V., Ansari, S., Shaibani, A. Tags: Electronic poster abstracts Source Type: research

E-031 Treatment of Acute Ischemic Stroke Due to Thrombosis of Stenotic Atherosclerotic Lesions of the Posterior Circulation
Conclusion Endovascular treatment can be performed with high rates of technical success for AIS due to thrombosis at chronic atherosclerotic lesions. In spite of potential for poor outcomes, significant recovery of function is possible following treatment. Further evaluation is warranted to identify those patients most likely to respond to such intervention. Disclosures M. Alexander: None. J. Rebhun: None. S. Hetts: 1; C; Stryker Neurovascular. 6; C; Stryker Neurovascular, statistical support services. D. Cooke: None.
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Alexander, M., Rebhun, J., Hetts, S., Cooke, D. Tags: Electronic poster abstracts Source Type: research

E-062 Intracranial Stenting for Atherosclerotic Disease with Aggressive Anti-platelet Therapy Management: A Consecutive Series of 154 Patients
Conclusions With aggressive monitoring and management of anti-platelet medications, intracranial stenting complications of stent thrombosis and distal emboli can be reduced, although there is still a significant risk of perforator strokes, particularly in the middle cerebral artery and basilar distributions. Disclosures M. Alexander: 1; C; Stryker Neurovascular. M. Nuno: None. J. Alexander: None. C. Agutos: None. W. Yu: 1; C; Stryker Neurovascular.
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Alexander, M., Nuno, M., Alexander, J., Agutos, C., Yu, W. Tags: Electronic poster abstracts Source Type: research

E-064 Safety and Efficacy of Balloon-Assisted Coiling of Intracranial Aneurysms: A Single-Center Study
Conclusions In our single-center study, balloon-assisted coiling was not associated with serious complications. Minimal intra-operative thrombi which were formed resolved with almost no adverse events in patient. Further studies will need to be performed on long term outcomes of these patients, however, balloon-assisted coiling has emerged as an important adjunct in the endovascular treatment of aneurysms. Disclosures V. Ramakrishnan: None. S. Quadri: None. A. Sodhi: None. V. Cortez: None. M. Taqi: None.
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Ramakrishnan, V., Quadri, S., Sodhi, A., Cortez, V., Taqi, M. Tags: Electronic poster abstracts Source Type: research

O-006 Analysis of Screened Patients from the Penumbra THERAPY Trial: Correlations of Clot Length Assessed by Thin-Section CT in a Sequential Series of Acute Stroke Patients
Conclusion This analysis further supports the idea of measuring hyperdense thrombus by use of thin-section NCCT. Occlusion site is a key predictor of clot length, which may explain the relative ineffectiveness of IV rtPA in more proximal anterior circulation large vessels. These findings suggest a sizeable population who may benefit from a bridging approach. Disclosures D. Frei: 3; C; Penumbra Inc. 4; C; Penumbra Inc. D. Heck: None. A. Yoo: 1; C; National Institutes of Health, Penumbra Inc., Remedy Pharmaceuticals. D. Loy: None. H. Buell: 5; C; Penumbra Inc. S. Kamalian: 1; C; GE Healthcare, Department of Defense, CIMIT. ...
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Frei, D., Heck, D., Yoo, A., Loy, D., Buell, H., Kamalian, S., Morais, L., Bitner, A., Meyer, D., Kuo, S., Bose, A., Sit, S. Tags: Oral abstracts Source Type: research

P-001 High-Resolution Optical and Angiographic CT Imaging of Flow-Diverter Stents for Assessment of Vessel Wall Apposition
Conclusion Due to its superior in-plane resolution, OCT clearly visualised the distinction between the vessel wall and the FD stent struts. Nevertheless, our example showed that VasoCT enables identification of apposition distances in the order of 0.5mm. Although OCT is clinically used in interventional cardiology, its neurovascular application is currently limited to the experimental setting. Here we showed that OCT can provide a gold-standard for the validation of VasoCT assessments of FD apposition. References Pierot L, Wakhloo AK. Stroke 2013;44:2046–2054 Kizilkilic O, et al. J Neurosurg 2012;117:45–49 F...
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: van der Marel, K., Gounis, M., King, R., Wakhloo, A., Puri, A. Tags: Oral poster abstracts Source Type: research

P-011 Early experience with TransForm™ Occlusion Balloon Catheter (OBC): A Single-Center Study
Conclusions In our single-center study, balloon remodeled coil embolization of aneurysm using TOBC was not associated with any serious complications. The balloon was trackable to intended site and the preparation time was relatively short. We believe that TOBC has good utility in treating broad-necked aneurysms and small aneurysms that are otherwise suboptimally managed by conventional deployment. Disclosures S. Quadri: None. V. Ramakrishnan: None. A. Sodhi: None. V. Cortez: None. M. Taqi: None.
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Quadri, S., Ramakrishnan, V., Sodhi, A., Cortez, V., Taqi, M. Tags: Oral poster abstracts Source Type: research

P-020 Emergent Carotid Artery Stenting with or without Intracranial Tandem Occlusion Lesions Following Carotid Endarterectomy
Conclusion Emergent endovascular evaluation in the setting of acute post CEA thrombosis is a safe and timely treatment option, with the benefit of detecting and treating embolic intracranial lesions. More investigation is necessary to define the role of immediate angiography and intervention in this rare surgical complication. Abstract P-020 Table 1Patient demographics AgeGender% Carotid stenosisSymptomaticCase 166M90NCase 273M80–99YCase 378M70YCase 459F80–99YCase 555M80–99NCase 680MUnknownUnknown Abstract P-020 Table 2Pre procedural metrics Time from CEA to symptoms (hrs)Time from last normal to throm...
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Vargas, J., Zuckerman, S., Chaudry, I., Turner, R., Turk, A., Spiotta, A. Tags: Oral poster abstracts Source Type: research

P-022 Flow Diversion in the Posterior Circulation: A Single Center Experience and Literature Review
Conclusion Posterior circulation flow diversion carries risks, but may represent a reasonable treatment option in carefully selected patients with high-risk aneurysms, which otherwise have and poor natural history and no optimal treatment strategy. Further data is necessary to assess the role of flow diversion in the posterior circulation. Disclosures G. Toth: None. M. Bain: None. S. Hussain: None. S. Moskowitz: None. P. Rasmussen: 1; C; ev3/Codman. 2; C; Codman. 4; C; Penumbra. 6; C; Blockade Medical. T. Masaryk: None. F. Hui: None.
Source: Journal of NeuroInterventional Surgery - July 26, 2014 Category: Neurosurgery Authors: Toth, G., Bain, M., Hussain, S., Moskowitz, S., Rasmussen, P., Masaryk, T., Hui, F. Tags: Oral poster abstracts Source Type: research

Hounsfield unit value and clot length in the acutely occluded vessel and time required to achieve thrombectomy, complications and outcome
Conclusions We have not found any significant associations between either thrombus length or density and likelihood of recanalization, time to achieve recanalization, intraprocedural complications, postprocedural hemorrhage or functional outcome at 90 days. These results do not support a predictive value for thrombus quantification in the evaluation of AIS.
Source: Journal of NeuroInterventional Surgery - June 28, 2014 Category: Neurosurgery Authors: Spiotta, A. M., Vargas, J., Hawk, H., Turner, R., Chaudry, M. I., Battenhouse, H., Turk, A. S. Tags: Ischemic stroke Source Type: research

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