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Santo BA, Ciecierska SSK, Mousavi Janbeh Sarayi SM, Jenkins TD, Baig AA, Monteiro A, Koenigsknecht C, Pionessa D, Gutierrez L, King RM, Gounis M, Siddiqui AH, Tutino VM. Tectonic infarct analysis: A computational tool for automated whole-brain infarct analysis from TTC-stained tissue. Heliyon 2023; 9:e14837. [PMID: 37025889 PMCID: PMC10070917 DOI: 10.1016/j.heliyon.2023.e14837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Background Infarct volume measured from 2,3,5-triphenyltetrazolium chloride (TTC)-stained brain slices is critical to in vivo stroke models. In this study, we developed an interactive, tunable, software that automatically computes whole-brain infarct metrics from serial TTC-stained brain sections. Methods Three rat ischemic stroke cohorts were used in this study (Total n = 91 rats; Cohort 1 n = 21, Cohort 2 n = 40, Cohort 3 n = 30). For each, brains were serially-sliced, stained with TTC and scanned on both anterior and posterior sides. Ground truth annotation and infarct morphometric analysis (e.g., brain-Vbrain, infarct-Vinfarct, and non-infarct-Vnon-infarct volumes) were completed by domain experts. We used Cohort 1 for brain and infarct segmentation model development (n = 3 training cases with 36 slices [18 anterior and posterior faces], n = 18 testing cases with 218 slices [109 anterior and posterior faces]), as well as infarct morphometrics automation. The infarct quantification pipeline and pre-trained model were packaged as a standalone software and applied to Cohort 2, an internal validation dataset. Finally, software and model trainability were tested as a use-case with Cohort 3, a dataset from a separate institute. Results Both high segmentation and statistically significant quantification performance (correlation between manual and software) were observed across all datasets. Segmentation performance: Cohort 1 brain accuracy = 0.95/f1-score = 0.90, infarct accuracy = 0.96/f1-score = 0.89; Cohort 2 brain accuracy = 0.97/f1-score = 0.90, infarct accuracy = 0.97/f1-score = 0.80; Cohort 3 brain accuracy = 0.96/f1-score = 0.92, infarct accuracy = 0.95/f1-score = 0.82. Infarct quantification (cohort average): Vbrain (ρ = 0.87, p < 0.001), Vinfarct (0.92, p < 0.001), Vnon-infarct (0.80, p < 0.001), %infarct (0.87, p = 0.001), and infarct:non-infact ratio (ρ = 0.92, p < 0.001). Conclusion Tectonic Infarct Analysis software offers a robust and adaptable approach for rapid TTC-based stroke assessment.
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Flotte TR, Cataltepe O, Puri A, Batista AR, Moser R, McKenna-Yasek D, Douthwright C, Gernoux G, Blackwood M, Mueller C, Tai PWL, Jiang X, Bateman S, Spanakis SG, Parzych J, Keeler AM, Abayazeed A, Rohatgi S, Gibson L, Finberg R, Barton BA, Vardar Z, Shazeeb MS, Gounis M, Tifft CJ, Eichler FS, Brown RH, Martin DR, Gray-Edwards HL, Sena-Esteves M. AAV gene therapy for Tay-Sachs disease. Nat Med 2022; 28:251-259. [PMID: 35145305 PMCID: PMC10786171 DOI: 10.1038/s41591-021-01664-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 12/17/2021] [Indexed: 12/17/2022]
Abstract
Tay-Sachs disease (TSD) is an inherited neurological disorder caused by deficiency of hexosaminidase A (HexA). Here, we describe an adeno-associated virus (AAV) gene therapy expanded-access trial in two patients with infantile TSD (IND 18225) with safety as the primary endpoint and no secondary endpoints. Patient TSD-001 was treated at 30 months with an equimolar mix of AAVrh8-HEXA and AAVrh8-HEXB administered intrathecally (i.t.), with 75% of the total dose (1 × 1014 vector genomes (vg)) in the cisterna magna and 25% at the thoracolumbar junction. Patient TSD-002 was treated at 7 months by combined bilateral thalamic (1.5 × 1012 vg per thalamus) and i.t. infusion (3.9 × 1013 vg). Both patients were immunosuppressed. Injection procedures were well tolerated, with no vector-related adverse events (AEs) to date. Cerebrospinal fluid (CSF) HexA activity increased from baseline and remained stable in both patients. TSD-002 showed disease stabilization by 3 months after injection with ongoing myelination, a temporary deviation from the natural history of infantile TSD, but disease progression was evident at 6 months after treatment. TSD-001 remains seizure-free at 5 years of age on the same anticonvulsant therapy as before therapy. TSD-002 developed anticonvulsant-responsive seizures at 2 years of age. This study provides early safety and proof-of-concept data in humans for treatment of patients with TSD by AAV gene therapy.
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Affiliation(s)
- Terence R Flotte
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, USA.
- Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research, UMass Chan Medical School, Worcester, MA, USA.
| | - Oguz Cataltepe
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, USA
- Department of Neurosurgery, UMass Chan Medical School, Worcester, MA, USA
| | - Ajit Puri
- Department of Radiology, UMass Chan Medical School, Worcester, MA, USA
| | - Ana Rita Batista
- Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research, UMass Chan Medical School, Worcester, MA, USA
- Department of Neurology, UMass Chan Medical School, Worcester, MA, USA
| | - Richard Moser
- Department of Neurosurgery, UMass Chan Medical School, Worcester, MA, USA
| | | | | | - Gwladys Gernoux
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, USA
- Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research, UMass Chan Medical School, Worcester, MA, USA
| | - Meghan Blackwood
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, USA
- Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research, UMass Chan Medical School, Worcester, MA, USA
| | - Christian Mueller
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, USA
- Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research, UMass Chan Medical School, Worcester, MA, USA
| | - Phillip W L Tai
- Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research, UMass Chan Medical School, Worcester, MA, USA
| | - Xuntian Jiang
- Department of Medicine and Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Scot Bateman
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, USA
| | - Spiro G Spanakis
- Departments of Anesthesiology and Perioperative Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Julia Parzych
- Departments of Anesthesiology and Perioperative Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Allison M Keeler
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, USA
- Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research, UMass Chan Medical School, Worcester, MA, USA
| | - Aly Abayazeed
- Department of Radiology, UMass Chan Medical School, Worcester, MA, USA
| | - Saurabh Rohatgi
- Department of Radiology, UMass Chan Medical School, Worcester, MA, USA
| | - Laura Gibson
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, USA
- Department of Internal Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Robert Finberg
- Department of Internal Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Bruce A Barton
- Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Zeynep Vardar
- Department of Radiology, UMass Chan Medical School, Worcester, MA, USA
| | | | - Matthew Gounis
- Department of Radiology, UMass Chan Medical School, Worcester, MA, USA
| | - Cynthia J Tifft
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Florian S Eichler
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Robert H Brown
- Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research, UMass Chan Medical School, Worcester, MA, USA
- Department of Neurology, UMass Chan Medical School, Worcester, MA, USA
| | - Douglas R Martin
- Scott-Ritchey Research Center, Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Heather L Gray-Edwards
- Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research, UMass Chan Medical School, Worcester, MA, USA
- Department of Radiology, UMass Chan Medical School, Worcester, MA, USA
| | - Miguel Sena-Esteves
- Horae Gene Therapy Center and The Li Weibo Institute for Rare Diseases Research, UMass Chan Medical School, Worcester, MA, USA.
- Department of Neurology, UMass Chan Medical School, Worcester, MA, USA.
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Ospel JM, van der Lugt A, Gounis M, Goyal M, Majoie CBLM. A clinical perspective on endovascular stroke treatment biomechanics. J Biomech 2021; 127:110694. [PMID: 34419825 DOI: 10.1016/j.jbiomech.2021.110694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/27/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022]
Abstract
Acute ischemic stroke (AIS) is caused by blockage of an arterial blood vessel in the brain by a thrombus, which interrupts oxygen supply to the brain parenchyma. The goal of endovascular stroke treatment (mechanical thrombectomy) is to restore blood flow as quickly and completely as possible. There are numerous factors that influence endovascular treatment success. They can be broadly grouped into a) factors related to blood vessels, b) factors related to the thrombus, c) factors related to endovascular treatment technique and tools and d) operator-related factors. While blood vessel and tgthro thrombus-related factors are mostly non-modifiable in the acute setting, operator and technique-related factors can be modified, and extensive research is currently being done to investigate the complex interplay of all these variables, and to optimize the modifiable factors to the maximum possible extent. In this review, we will describe these factors and how they interact with each other in detail, and outline some of their practical implications. We will conclude with a short summary and outlook on future directions for optimizing endovascular treatment success.
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Affiliation(s)
- Johanna M Ospel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Neuroradiology, University Hospital Basel, Basel, Switzerland; Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - Matthew Gounis
- Department of Radiology, University of Massachusetts Medical School, Worcester, United States
| | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Charles B L M Majoie
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Vargas Machaj J, Blalock J, Venkatraman A, Anagnostakou V, King R, Ewing JA, Gounis M, Turner R, Chaudry I, Turk A. Abstract P561: Efficacy of Beveled Tip Aspiration Catheter in Mechanical Thrombectomy for Acute Ischemic Stroke. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The ADAPT technique uses large bore aspiration catheters for mechanical thrombectomy. Several aspiration catheters are now available. We report a bench-top exploration of a beveled-tip catheter, and our experience in treating large vessel occlusions using next-generation aspiration catheters.
Methods:
Twenty experiments were conducted with either a Sofia Plus or a Zoom71 using a vascular phantom in which a clot model was introduced. Rate of ingestion, complete recanalization after a single attempt, and pressure at the catheter tip for both devices were recorded. A retrospective analysis from a prospectively-maintained database was performed. Patient demographics, periprocedural metrics, discharge and 90-day modified Rankin Scales were collected. Patients were divided into two groups based on which aspiration catheter was used.
Results:
In our bench-top experiment, complete ingestion of the clot occurred in 90% of beveled tip and 20% of control device experiments (p=0.006). Our clinical data demonstrated no significant difference in age, gender, IV tPA administration, admission NIHSS, baseline mRS, or LVO location between the beveled tip and flat tip groups. With the beveled tip, TICI 2C or better recanalization was more frequent (93.2% vs 74.2%, p-value 0.017), stent retriever usage was lower (9.1% versus 29%, p-value 0.024), and patients had lower mRS on discharge (median 3 vs 4, p less than 0.001) and at 90 days (median 2 vs 4, p=0.008).
Conclusion:
The beveled tip design leads to more frequent clot ingestion in a bench top model, which may translate into a more efficacious thrombectomy device with improved outcomes.
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Affiliation(s)
| | | | | | | | - Robert King
- Radiology, Univ of Massachusetts Med Sch, Worcester, MA
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Brinjikji W, Fitzgerald S, Kallmes DF, Layton K, Hanel R, Pereira VM, Kvamme P, Delgado J, Yoo A, Jahromi B, Almekhlafi M, Gounis M, Nogueira RG. Abstract 147: Outcomes of the Stroke Thromboembolism Registry of Imaging and Pathology: A Multicenter International Study. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
We performed a multicenter prospective clinical registry across 11 centers to study the association between histopathological characteristics of retrieved clots and imaging, stroke etiology and clinical outcomes.
Materials and Methods:
Following IRB approval at the 11 centers, patients were enrolled in the STRIP registry. All retrieved emboli were sent for histopathological analysis with H&E and MSB staining. Demographic variables, comorbidities, stroke etiology, imaging findings and procedural details were collected for each case. We studied the association between clot histopathology and imaging findings, stroke etiology and and revascularization outcomes. Student’s t-test was used for continuous variables and chi-squared testing for categorical variables.
Results:
To date, 1022 patients have been included. There was a significant correlation between platelet rich clots and the absence of hyperdensity on non-contrast CT [p=0.321, p=0.003) and a significant inverse correlation between the percentage of platelets and mean HU on NCCT (p=-0.243, p=0.025). The proportion of platelet-rich clots (55.0% versus 21.2%, p=0.005) and the percentage of platelet content (22.1% versus 13.9%, p=0.03) was significantly higher in patient with large artery atherosclerosis compared to those with a cardioembolic etiology. There was no correlation between RBC density, WBC density, fibrin density or platelet density and revascularization outcomes with stent-retrievers. However, we have found that with aspiration alone, patients with platelet rich clots are less likely to be fully revascularized (i.e. TICI 2c/3) than non-platelet rich clots (OR=0.36, 95%CI=0.12-0.81, P<.0001). Meanwhile, patients with RBC rich clots are more likely to be completely revascularized with aspiration alone than those with RBC poor clots (OR=2.71, 95%CI=1.25-3.24, P=0.02).
Conclusions:
Interim analysis of the STRIP registry suggests that the platelet content of a clot may be the most revealing factor in determining a clot’s etiology, imaging features and revascularization outcome. Platelet rich clots are less dense on NCCT, are associated with a large artery atherosclerosis source and are less likely to be completely revascularized with aspiration alone.
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Affiliation(s)
| | | | | | | | - Ricardo Hanel
- Lyerly Neurosurgery/Baptist Neurological Institute, Jacksonville, FL
| | | | | | | | - Albert Yoo
- Texas Stroke Institute, Dallas Fort Worth, TX
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Puri AS, Ughi G, King RM, Gounis M. Abstract WP1: High-Frequency Optical Coherence Tomography for Cerebrovascular Disease. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Optical coherence tomography (OCT) has played an important role in the diagnosis and treatment guidance in coronary artery disease. However, existing OCT systems are not suitable for routine neurovascular applications due to the size and tortuosity of the arteries.
Hypothesis:
We seek to demonstrate a prototype high-frequency OCT (HF-OCT) capable of high-resolution imaging in simulated cerebrovascular anatomy.
Methods:
A low-profile HF-OCT system was constructed with an image resolution approaching 10μm. Using an in vitro, patient-specific model of the circle of Willis with circulating porcine blood, we characterized the delivery of the device and ability to image in a tortuous path. Also, human cadaver intracranial atherosclerosis plaques were imaged with HF-OCT and assessed by an expert imager. Finally, neurovascular devices were implanted in 8 pigs (Fig 1) and HF-OCT imaging was compared with gold-standard DSA and CT.
Results:
In the phantom, optimal blood clearance was achieved through an intermediate catheter (5 Fr Navien) with infusion of contrast at 5 ml/s in the internal carotid and basilar artery, and 3 ml/sec in the MCA. The in vivo study demonstrated that both malapposition of devices or thrombus formation along the device surface could be reliably diagnosed among 3 reviewers (Fleiss’s kappa of 0.87 and 0.9, respectively). This agreement was superior to DSA and CT. Imaging in tortuous swine brachial showed in all cases imaging free of artifacts, uniform illumination and ability to visualize vessel wall layers. Plaque types including ‘lipid pools’, fibrotic, and calcific tissue from cadaver specimens of ICAD could be adequately depicted by HF-OCT.
Conclusion:
In vitro, in vivo and ex vivo characterization of a novel HF-OCT device has shown it is capable of imaging in the tortuous intracranial vascular anatomy. This technology has to potential to aid in the diagnosis of cerebrovascular disease and guide optimal endovascular treatment.
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Aquarius R, de Korte A, Smits D, Gounis M, Verrijp K, Driessen L, Leenders W, de Vries J. The Importance of Wall Apposition in Flow Diverters. Neurosurgery 2020; 84:804-810. [PMID: 29659995 DOI: 10.1093/neuros/nyy092] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/27/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is assumed that high pore densities in flow diverters (FDs) are beneficial for intracranial aneurysm (IA) healing. However, various animal studies are not conclusive on the issue, suggesting that other factors are in play. One important factor might be wall apposition. OBJECTIVE To (1) determine the relationship between FD pore density and aneurysm occlusion, and (2) determine the relationship between FD wall apposition and aneurysm occlusion. METHODS Saccular aneurysms were microsurgically created in the aorta of 36 Wistar rats. Twelve rats received a low pore density FD (10 pores/mm2), 12 rats received a high pore density FD (23 pores/mm2), and the remaining 12 rats served as a control group. Six animals from each group were sacrificed 1 and 3 mo after surgery. We determined aneurysm occlusion, the number of struts not in contact with the aorta wall, and the average distance from malapposed struts to aorta wall through histology. RESULTS No significant differences were found in aneurysm occlusion between the low pore density and high pore density groups (P > .05) after 1 and 3 mo of follow-up. The average number of malapposed struts was lower for the occluded aneurysm group (4.4 ± 1.9) compared to the nonoccluded aneurysm group (7.7 ± 2.6, P < .01). The average distance between malapposed struts and parent artery wall was lower for the occluded aneurysm group (33.9 μm ± 11.5 μm) than for the nonoccluded aneurysm group (48.7 μm ± 18.8 μm, P < .05). CONCLUSION Wall apposition is more important than pore density for aneurysm occlusion.
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Affiliation(s)
- René Aquarius
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antonius de Korte
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Debby Smits
- Central Animal Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthew Gounis
- Department of Radiology, Division of Neuroimaging and Intervention and New England Center for Stroke Research University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kiek Verrijp
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Léon Driessen
- Orthopaedic Research Laboratory Radboud University Medical Center, Nijmegen, The Netherlands
| | - William Leenders
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost de Vries
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
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MacDonell J, Patel N, Fischer G, Burdette EC, Qian J, Chumbalkar V, Ghoshal G, Heffter T, Williams E, Gounis M, King R, Thibodeau J, Bogdanov G, Brooks OW, Langan E, Hwang R, Pilitsis JG. Robotic Assisted MRI-Guided Interventional Interstitial MR-Guided Focused Ultrasound Ablation in a Swine Model. Neurosurgery 2019; 84:1138-1148. [PMID: 29905844 PMCID: PMC6500887 DOI: 10.1093/neuros/nyy266] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/21/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ablative lesions are current treatments for epilepsy and brain tumors. Interstitial magnetic resonance (MR) guided focused ultrasound (iMRgFUS) may be an alternate ablation technique which limits thermal tissue charring as compared to laser therapy (LITT) and can produce larger ablation patterns nearer the surface than transcranial MR guided focused ultrasound (tcMRgFUS). OBJECTIVE To describe our experience with interstitial focused ultrasound (iFUS) ablations in swine, using MR-guided robotically assisted (MRgRA) delivery. METHODS In an initial 3 animals, we optimized the workflow of the robot in the MR suite and made modifications to the robotic arm to allow range of motion. Then, 6 farm pigs (4 acute, 2 survival) underwent 7 iMRgFUS ablations using MRgRA. We altered dosing to explore differences between thermal dosing in brain as compared to other tissues. Imaging was compared to gross examination. RESULTS Our work culminated in adjustments to the MRgRA, iMRgFUS probes, and dosing, culminating in 2 survival surgeries; swine had ablations with no neurological sequelae at 2 wk postprocedure. Immediately following iMRgFUS therapy, diffusion-weighted imaging, and T1 weighted MR were accurate reflections of the ablation volume. T2 and fluid-attenuated inversion-recovery (FLAIR) images were accurate reflections of ablation volume 1-wk postprocedure. CONCLUSION We successfully performed MRgRA iFUS ablation in swine and found intraoperative and postoperative imaging to correlate with histological examination. These data are useful to validate our system and to guide imaging follow-up for thermal ablation lesions in brain tissue from our therapy, tcMRgFUS, and LITT.
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Affiliation(s)
| | - Niravkumar Patel
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Gregory Fischer
- Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | | | - Jiang Qian
- Department of Pathology, Albany Medical College, Albany, New York
| | | | | | | | | | - Matthew Gounis
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert King
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Gene Bogdanov
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Olivia W Brooks
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Erin Langan
- Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Roy Hwang
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
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Marosfoi M, Langan E, Strittmatter L, Marel KVD, Arends J, Loganathan S, Hendricks G, Puri A, Wakhloo A, Gounis M. O-016 In Situ Tissue Engineering: Endothelial Growth Patterns as a Function of Flow Diverter Design. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kuhn A, Lozano J, de Macedo Rodrigues K, Massari F, Wakhloo A, Rex D, Gounis M, Marosfoi M, Perras M, Brooks C, Howk M, Puri A. E-040 Five-year Single Center Experience of Intracranial Aneurysm Treatment with the PED in Patients of different Age Groups. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ansari S, Kuhn A, Honarmand A, Hou S, Khan M, Chueh J, Bom IVD, Hurley M, Shaibani A, Gounis M, Potts M, Jahromi B, Wakhloo A, Puri A. O-012 Emergent Endovascular Management of Long-segment Carotid Artery Dissections in Acute Ischemic Stroke Intervention with Multiple Tandem Stents. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lozano J, Howk M, Kuhn A, Massari F, de Macedo Rodrigues K, Brooks C, Perras M, Gounis M, Rex D, Wakhloo A, Puri A. E-020 Between a Rock and a Hard Place: The Use of Self-expanding Stents for the Endovascular Treatment of Acute Ischemic Stroke due to Recalcitrant Emergency Large Vessel Occlusion in the Era of Stent-retrievers: Single-center Experience and Early Results. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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de Macedo Rodrigues K, Kühn A, Tamura T, Dabus G, Kan P, Marosfoi M, Lozano J, Howk M, Perras M, Brooks C, Rex D, Massari F, Gounis M, Wakhloo A, Puri A. E-091 Treatment of Aneurysms of the Pericallosal Artery with the Pipeline Embolization Device. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chueh J, Marosfoi M, Langan E, Puri A, Gounis M. E-047 Distal Emboli Following ERIC Thrombectomy. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jankowitz B, Iannaccone F, De Santis G, De Beule M, Gounis M, Van Der Marel K, Puri A. E-064 Adjunctive Stent are Not Flow Diverters: A Computational Flow Dynamics Study Comparing Flow Diverters to Adjunctive Stents. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Marosfoi M, Langan E, King R, Clarençon F, Lylyk I, Brooks O, Slazas R, Puri A, Gounis M. E-005 Aneurysm Treatment with a New Generation Flow Diverter. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chueh J, Turan T, van der Marel K, LeMatty T, Brown T, Ansari S, Carroll T, Buck A, Zhou X, Chatterjee A, King R, Zheng S, Swartz R, Feldmann E, Gounis M. E-016 An Atherosclerotic Plaque Phantom for Medical Imaging. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Marosfoi M, Langan E, Vedantham S, Clarençon F, King R, Wainwright J, Gounis M, Puri A. O-029 Acute Thrombus Formation on Flow Diverters Imaged In Vivo Using Optical Coherence Tomography. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kuhn A, de Macedo Rodrigues K, Gounis M, Kan P, Marosfoi M, Lozano J, Perras M, Brooks C, Howk M, Rex D, Massari F, Wakhloo A, Puri A. E-070 Endovascular Techniques for Achievement of Better Flow Diverter Wall Apposition. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gounis M. WE-DE-207A-03: Recent Advances in Devices Used in Neuro--Interventions. Med Phys 2016. [DOI: 10.1118/1.4957848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lozano J, Massari F, Brooks C, Perras M, Howk M, Gounis M, Henninger N, Wakhloo A, Puri A. E-050 last chance carotid stenting: treatment and outcomes of carotid artery stenting in very high risk patients. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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van der Marel K, Vedantham S, van der Bom I, Howk M, Narain T, Gounis M, Puri A, Wakhloo A. E-101 reduced patient radiation exposure during diagnostic and interventional x-ray angiography with novel imaging platform. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kuhn A, Massari F, Lozano J, Hou S, Howk M, Perras M, Brooks C, Kan P, Gounis M, Wakhloo A, Puri A. E-131 endovascular reconstruction of intradural vertebral artery fusiform dissecting aneurysms with the pipeline embolization device. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Massari F, Henninger N, Lozano J, Howk M, Perras M, Brooks C, Gounis M, Wakhloo A, Puri A. P-014 arts (ace-retriever technique for stroke): initial clinical experience. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chueh J, Turan T, Brown T, LeMatty T, Mao H, Swartz R, Feldmann E, Rappleye J, van der Marel K, Gounis M. E-121 an atherosclerotic plaque phantom for medical inaging. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Golebiowski D, Petrosky K, Van der Marel K, Hutto E, Curran E, Balkanska-Sinclair E, Bishop N, Santos R, Cummings Macri S, Martin D, Gounis M, Pilitsis J, Asaad W, Sena-Esteves M. 710. Optimization of AAV Vector Design for Safe Expression of β-N-Acetylhexosaminidase in the Brain for Tay-Sachs Disease Gene Therapy. Mol Ther 2015. [DOI: 10.1016/s1525-0016(16)34319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Golebiowski D, Bradbury AM, Kwon CS, van der Bom IMJ, Stoica L, Johnson AK, Wilson DU, Gray-Edwards HL, Hudson JA, Johnson JA, Randle AN, Whitlock BK, Sartin JL, Kühn AL, Gounis M, Asaad W, Martin DR, Sena-Esteves M. AAV Gene Therapy Strategies for Lysosomal Storage Disorders with Central Nervous System Involvement. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/978-1-4939-2306-9_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Puri A, Massari F, Hou S, Perras M, Brooks C, Stout C, Gounis M, Wakhloo A. E-041 Use of Flow Diverters in the Endovascular Reconstruction of Fusiform Dissecting Vertebral Artery Aneurysms. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van der Marel K, Gounis M, King R, Wakhloo A, Puri A. P-001 High-Resolution Optical and Angiographic CT Imaging of Flow-Diverter Stents for Assessment of Vessel Wall Apposition. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Massari F, Puri A, Hou S, Perras M, Brooks C, Stout C, Gounis M, Wakhloo A. P-007 Incidence and Management of Intimal Hyperplasia at 6 months after Flow Diversion for Intracranial Aneurysms. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chueh J, Puri A, Wakhloo A, Gounis M. O-033 Aspiration Efficacy of Suction Catheter in the Management of Distal Embolization During Interventional Treatment of Acute Ischemic Stroke. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Puri A, Massari F, Hou S, Perras M, Brooks C, Stout C, Gounis M, Wakhloo A. E-042 Use of Flow Diverters in Vessels less than 2.5 mm during Intracranial Aneurysm Treatment. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gounis M, Bom IVD, Wakhloo A, Zheng S, Weaver J, Puri A, Kuhn A, Bogdanov A. O-014 Modelling Unstable Brain Aneurysms: MR Molecular Imaging of Myeloperoxidase in the Aneurysm Wall and Correlation with Human Pathology. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wakhloo A, Lylyk P, Vries JD, Biondi A, Taschner C, Hartmann M, Szikora I, Pierot L, Sakai N, Sourour N, Rennie I, Skalej M, Mery F, Turjman F, Brouwer P, Boccardi E, Gounis M, Surpass T. O-008 A New Generation of Flow Diverters for Endovascular Treatment of Intracranial Aneurysms - A Multicentre Preliminary Clinical and Angiographic Experience in 161 patients with 186 Aneurysms. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Flood T, Bom IVD, Strittmatter L, Hendricks G, Puri A, Wakhloo A, Gounis M. P-016 Quantitative Assessment of Stent Induced Neointimal Hyperplasia with Contrast Enhanced Cone-Beam CT: In Vivo Validation with Histomorphometry. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bom IVD, Zheng S, Gounis M. E-023 Towards Non-Invasive Flow-Insensitive Magnetic Resonance Angiography Using AngioCEST - A Preliminary Study. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Puri A, Kuhn A, Hou S, Khan M, Chueh J, Bom IVD, Gounis M, Wakhloo A. E-047 Endovascular management of long segment carotid and vertebral artery dissections with multiple overlapping stents. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Puri A, Kuhn A, Hou S, Khan M, Gounis M, Wakhloo A. E-048 Endovascular Treatment of Very Small Aneurysms in the Anterior and Posterior Circulation - Safety and Efficacy Analysis. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van der Bom I, Wakhloo A, Kuhn A, Ding L, Goff D, Gounis M. P-017 Radiation target delineation of micro brain arteriovenous malformations using high-resolution flat-detector cone-beam Computed Tomography (CBCT): Abstract P-017 Figure 1. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455b.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chueh J, Kuhn A, Wilson S, Estrada C, Gounis M. O-017 Reduction in distal emboli with proximal flow control during mechanical thrombectomy: a quantitative in vitro study. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455a.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hou S, Gounis M, Wakhloo A. E-053 Activated clotting time measurements are essential for monitoring effective anti-coagulation during endovascular neurosurgical procedures requiring the use of heparin. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Samaniego EA, Tari-Capone F, Linfante I, Silva CF, Spilberg G, Gounis M, Wakhloo AK, Dabus G. Wingspan experience in the treatment of symptomatic intracranial atherosclerotic disease after antithrombotic failure. J Neurointerv Surg 2012; 5:302-5. [PMID: 22544819 DOI: 10.1136/neurintsurg-2012-010321] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial stenting with the Wingspan system has been used as a revascularization strategy in symptomatic patients with intracranial atherosclerotic disease (ICAD). The latest results of the Stenting versus Aggressive Medical Therapy for Intracranial Artery Stenosis (SAMMPRIS) trial challenge this approach. Our experience in the treatment of symptomatic ICAD with the Wingspan system is reported. MATERIALS AND METHODS Patients who underwent stenting for symptomatic ICAD were included in the analysis. Demographic data, periprocedural complications, long term radiological and clinical outcomes are reported. RESULTS 46 lesions were treated in 45 patients. 13 patients (29%) presented with a transient ischemic attack and 32 (71%) with a stroke. 43 patients (95.5%) failed antithrombotic therapy at presentation. One (2%) symptomatic periprocedural (24 h) complication occurred. The 30 day incidence of stroke and vascular death was 6.6%--a fatal hemorrhagic stroke and two non-fatal hemorrhagic strokes. In-stent stenosis (≥50%) was seen in nine (42.8%) lesions, two were symptomatic. CONCLUSIONS This cohort of patients with symptomatic ICAD who failed antithrombotic medications benefited from angioplasty and stenting with the Wingspan system.
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Affiliation(s)
- Edgar A Samaniego
- Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, FL 33156, USA
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Nogueira RG, Levy EI, Gounis M, Siddiqui AH. The Trevo device: preclinical data of a novel stroke thrombectomy device in two different animal models of arterial thrombo-occlusive disease. J Neurointerv Surg 2011; 4:295-300. [PMID: 21990512 DOI: 10.1136/neurintsurg-2011-010053] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The currently available mechanical devices fail to achieve recanalization in as many as 20-40% of proximal arterial occlusion strokes. OBJECTIVE The preclinical evaluation of the safety and efficacy of a novel thrombectomy device designed to achieve immediate flow restoration by quickly removing clot is reported. METHODS Four 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. RESULTS A 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. Thrombolysis in Myocardial Infarction (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. CONCLUSION The experimental data suggest that the Trevo device is highly effective at achieving immediate reperfusion of occluded arteries without causing any clinically significant disruption of vascular integrity.
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Affiliation(s)
- Raul G Nogueira
- Department of Neurology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA.
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Spilberg G, Carniato S, King R, Murphy R, Gounis M, Wakhloo A. O-030 MRA artifact evaluation of an in vivo canine model: 28 weeks follow-up of aneurysms treated with endovascular coiling. J Neurointerv Surg 2011. [DOI: 10.1136/neurintsurg-2011-010097.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Carniato S, Mehra M, King R, Wakhloo A, Gounis M. O-023 Pre-clinical model of porcine arterial tortuosity for in vivo testing of neuroendovascular devices. J Neurointerv Surg 2011. [DOI: 10.1136/neurintsurg-2011-010097.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gounis M, Nogueira R, Mehra M, Finol E, Yang Y, Jahrmarkt S, Migliuolo M, Wakhloo A. O-006 Pharmaco-mechanical clot disruption using a balloon infusion wire in an acute rabbit common carotid artery thromboembolic occlusion model. J Neurointerv Surg 2011. [DOI: 10.1136/neurintsurg-2011-010097.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vedantham S, Gounis M, Wakhloo A, Karellas A. SU-E-I-97: A Protocol for Attenuation Characterization of Neurovascular Devices under Fluoroscopic Conditions. Med Phys 2011. [DOI: 10.1118/1.3611671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Vogl TJ, Pflugmacher R, Hierholzer J, Stender G, Gounis M, Wakhloo A, Fiebig C, Hammerstingl R. Vergleich eines „cement-directing Kyphoplastiesystems“ mit der perkutanen Vertebroplastie bezüglich Zementleckage: Ergebnisse einer kontrollierten randomisierten Studie. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gounis M, Patel N, Norbash A, Lee S, Noordhoek N, Blijd J, Babic D, Wakhloo A. O-009 Cone beam CT of cerebrovascular stents. J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003244.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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