Rehabilitation of hand function after spinal cord injury using a novel handgrip device: a pilot study

BackgroundActivity-based therapy (ABT) for patients with spinal cord injury (SCI), which consists of repetitive use of muscles above and below the spinal lesion, improves locomotion and arm strength. Less data has been published regarding its effects on hand function. We sought to evaluate the effects of a weekly hand-focused therapy program using a novel handgrip device on grip strength and hand function in a SCI cohort.MethodsPatients with SCI were enrolled in a weekly program that involved activities with the MediSens (Los Angeles, CA) handgrip. These included maximum voluntary contraction (MVC) and a tracking task that required each subject to adjust his/her grip strength according to a pattern displayed on a computer screen. For the latter, performance was measured as mean absolute accuracy (MAA). The Spinal Cord Independence Measure (SCIM) was used to measure each subject's independence prior to and after therapy.ResultsSeventeen patients completed the program with average participation duration of 21.3 weeks. The cohort included patients with American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (n = 12), AIS B (n = 1), AIS C (n = 2), and AIS D (n = 2) injuries. The average MVC for the cohort increased from 4.1 N to 21.2 N over 20 weeks, but did not reach statistical significance. The average MAA for the cohort increased from 9.01 to 21.7% at the end of the study (p = .02). The cohort's average SCIM at the end of the study was unchanged compared to baseline.ConclusionsA weekly handgrip-based ABT program is feasible and efficacious at increasing hand task performance in subjects with SCI

Predicting the effects of epidural stimulation in patients with spinal cord injury: An active learning-based solution using dynamic sample weighting

Data for patient's experimental sessions conducted over a 29 week perio

Replication Data for: A novel analytical solution for predicting the optimal discharge time following acute inpatient rehabilitation

Data from admissions to an acute rehabilitation center in southern California that was used to train models for predicting discharge Functional Independence Measure and length of stay

Abstract 1122‐000117: Transcranial Arterial Embolization of an dAVF: A Case Report

Introduction: We detail the management of a woman with a posterior fossa dAVF (dural arteriovenous fistula) that was unable to be treated by standard transarterial or transvenous embolization or microsurgical ligation. She underwent craniotomy for surgical exposure and direct access of her left middle meningeal artery followed by microcatheter embolization with favorable results. Methods: This is a case report, which describes a case of a difficult to access dAVF. Results: A 72 year‐old woman presented with vertigo, nausea, and vomiting one week following a fall. CT head disclosed cerebellar vermis intraparenchymal hematoma and CT head angiography was suspicious for underlying vascular malformation. Diagnostic cerebral angiogram demonstrated extensive tentorial and suboccipital dural arteriovenous fistula (dAVF) fed by branches of both middle meningeal and occipital arteries with direct cortical venous drainage and venous aneurysmal ectasia directly adjacent to the vermian hemorrhage (ruptured Cognard grade 4). Left vertebral artery angiogram demonstrated excessive tortuosity of vertebral enlarged posterior meningeal artery, which was unable to be catheterized sufficiently beyond its origin despite different microwires and microcatheters due to tortuosity. Transfemoral venous approach was also attempted, however, this was also unsuccessful and decision was made to proceed with microsurgical treatment. The following day a suboccipital craniotomy was performed, but was ultimately aborted due to nearly uncontrollable bleeding from bony exposure and dural access secondary to severe venous hypertension. The next day percutaneous endovascular treatment was attempted a second time. A small right middle meningeal artery (MMA) contribution to the fistula was embolized with liquid embolic but, again because of excessive tortuosity and insufficient microcatheter access, right MMA occlusion occurred without embolic agent reaching the fistula. Similar access related difficulties due to tortuosity were encountered in accessing the left middle meningeal and occipital arteries contributing to the fistula. Repeat transvenous access was also attempted from the occipital and right transverse sinuses, but microcatheter access to the fistula was unable to be established beyond the venous outflow from the aneurysm, and, given the risks of hemorrhage related to embolization of the venous outflow without occluding arterial inflow into the ruptured aneurysm, transvenous embolization was not performed. A few days later, after the patient was given time to recover from the prior procedures, the patient underwent left temporal craniotomy in a hybrid operating room/interventional radiology suite for direct cannulation of the left MMA. Localization of the craniotomy site over the left MMA access point was planned by transfemoral cerebral angiogram and a transcarotid/peripheral access kit was used to catheterize the left MMA directly following surgical exposure. An .017 microcatheter was advanced close to the fistula point using standard biplanar roadmap fluoroscopy, and Onyx embolization of the fistula was performed to complete occlusion, without complication. Conclusions: For cerebrovascular disorders that are inaccessible by traditional endovascular and surgical means, a hybrid approach should be considered

Abstract Number ‐ 122: Minimally symptomatic left M1 occlusion from carotid web

Introduction Minimally symptomatic large vessel occlusion (LVO) is an area of prognostic and management uncertainty. Current guidelines recommend thrombectomy only for patients with NIHSS of 6 or greater when additional timeline and imaging criteria are met. However, patients with initial mild or rapidly improving symptoms with LVO can eventually deteriorate, raising the question of whether all patient with acute LVO should be offered thrombectomy. Methods We present a case of minimally symptomatic M1 occlusion due to ipsilateral carotid web managed without thrombectomy. Results A 42‐year‐old woman with Systemic Lupus Erythematosus (SLE) and hypertension presented to an outside hospital with sudden transient left monocular vision loss, aphasia, right‐side weakness, and dizziness. At the time of presentation (1h from LKW) exam revealed only mild aphasia (NIHSS 1) with normal blood pressure. CTA demonstrated left M1 occlusion with reconstitution of flow at the M2 bifurcation. She was given IV Alteplase and transferred to our center. On 7 h from LKW repeat imaging demonstrated persistence of the left M1 occlusion with an ipsilateral near‐occlusion suspicious for carotid web at the ICA origin, but exam was without deficit. She was monitored closely for neurological deterioration, but remained without significant symptoms. MRA taken the next day demonstrated complete recanalization of the left M1. She was taken to the angiography suite on an outpatient basis for stenting of the carotid web at the origin of the internal carotid artery. Initial diagnostic angiogram revealed near occlusion of the ICA at the origin with post‐stenotic dilation, which was treated with angioplasty and stenting with distal embolic protection. She has remained stable to 8‐month follow‐up with no recurrent stroke. Conclusions Minimally symptomatic LVO presents significant endovascular management uncertainty. While clinical trials support the use of mechanical thrombectomy for significantly symptomatic patients, there is no consensus to guide treatment decisions for patients with minimal symptoms. This uncertainty is driven at least in part by an inability to reliably distinguish between patients who are likely to progress and would benefit from intervention before their collateral circulation fails, and those who will recanalize or develop a compensated chronic occlusion. In this case, our patient received tPA and saw symptom improvement, but this did not remove her M1 occlusion. Angiographic investigation was limited as the patient was asymptomatic, however non‐invasive imaging revealed robust collateralization including reconstitution of MCA flow and left ICA injection failed to opacify the ipsilateral ACA despite patency in recent CT angiography, indicating a right to left flow dominance in circle of Willis collaterals. We opted for close monitoring with follow‐up imaging and outpatient correction of the carotid web, which resulted in a positive outcome. More work is needed to establish criteria to predict which patients with minimally symptomatic LVO are likely to progress

Abstract Number ‐ 145: Impact of Landmark Trials on Intracranial Stenting Utilization for Intracranial Atherosclerotic Disease in the US

Introduction The Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial published in 2010 showed aggressive medical therapy is superior to percutaneous transluminal angioplasty and stenting (PTAS) for intracranial atherosclerotic disease (ICAD). Following the pivotal positive mechanical thrombectomy (MT) trials in 2015, MT utilization in the United States (US) has increased. Rescue ICAD stenting may be needed in MT patients with underlying ICAD but it remains uncertain whether PTAS use for ICAD has changed over this time. The aim of this study is to describe national trends in the utilization of PTAS for ICAD in the US before and after SAMMPRIS and following the pivotal MT trials. Methods We used a constellation of International Classification of Diseases ninth and tenth revision diagnostic/procedural codes to identify all elective and non‐elective adult (> = 18 years) ICAD admissions with or without infarction containing concomitant codes for PTAS in the 2007–2019 National Inpatient Sample. Admissions containing codes for subarachnoid hemorrhage, unruptured intracranial aneurysms or benign intracranial hypertension were excluded. We combined weighted counts of PTAS admissions with annual US adult census data to obtain prevalence of PTAS. We used joinpoint regression to evaluate trends in PTAS use over time. Results Across the study period, there were 16,477 weighted admissions for ICAD undergoing PTAS in the US. 52.4% of these admissions were in patients 60–79years and 43.2% were in women. 74.3% of these admissions were non‐elective and this proportion increased over time (P = 0.019). 26.5% of all admissions had concurrent codes for MT but this proportion increased by almost ten‐fold over time from 4.3% in 2007 to 40.0% in 2019. On join point regression, PTAS utilization increased but insignificantly from 3.0/million population in 2007 to 5.7/million population in 2010 (Annualized percentage change, APC 11.2%, 95%CI ‐11.8 to 40.3, p = 0.290), declined also insignificantly from 2010–2013 (APC ‐13.2, 95%CI ‐48.4 to 45.8, p = 0.514) and increased significantly from 3.55/million in 2013 to 3.80/million in 2014 and exponentially across the rest of the period to 8.4 cases/million in 2019 (APC 15.4, 95%CI 9.2 to 22.0, p = 0.001). Upon stratification by admission type, most of the increase across the period 2013/2014 to 2019 occurred in non‐elective admissions (Figure 1). Utilization in elective admissions varied from 0.92 to 1.96 cases per million population but this did not change significantly across the study period. Conclusions PTAS utilization for ICAD declined in the US after SAMMPRIS but has increased following publication of pivotal MT trials mainly in non‐elective admissions. PTAS utilization increased significantly following publication of pivotal MT trials likely in ICAD patients who required rescue stenting.. Additional prospective studies are needed to determine the long‐term outcomes of concurrent PTAS and MT as this is not a group of patients that was studied in SAMMPRIS