Factors Affecting Selection of TraineE for Neurointervention (FASTEN)

BACKGROUND AND IMPORTANCE: Neurointervention is a very competitive specialty in the United States due to the limited number of training spots and the larger pool of applicants. The training standards are continuously updated to ensure solid training experiences. Factors affecting candidate(s) selection have not been fully established yet. Our study aims to investigate the factors influencing the selection process. METHODS: A 52-question survey was distributed to 93 program directors (PDs). The survey consisted of six categories: (a) Program characteristics, (b) Candidate demographics, (c) Educational credentials, (d) Personal traits, (e) Research and extracurricular activities, and (f) Overall final set of characteristics. The response rate was 59.1%. As per the programs\u27 characteristics, neurosurgery was the most involved specialty in running the training programs (69%). Regarding demographics, the need for visa sponsorship held the greatest prominence with a mean score of 5.9 [standard deviation (SD) 2.9]. For the educational credentials, being a graduate from a neurosurgical residency and the institution where the candidate\u27s residency training is/was scored the highest [5.4 (SD = 2.9), 5.4 (SD = 2.5), respectively]. Regarding the personal traits, assessment by faculty members achieved the highest score [8.9 (SD = 1)]. In terms of research/extracurricular activities, fluency in English had the highest score [7.2 (SD = 1.9)] followed by peer-reviewed/PubMed-indexed publications [6.4 (SD = 2.2)]. CONCLUSION: Our survey investigated the factors influencing the final decision when choosing the future neurointerventional trainee, including demographic, educational, research, and extracurricular activities, which might serve as valuable guidance for both applicants and programs to refine the selection process

Abstract 1122‐000183: Assessing Meningeal Lymphatic MRI Biomarkers in Acute Large Vessel Occlusion Stroke Treated with Thrombectomy

Introduction : Until recently, there was very little known about the brain’s waste removal system. Unlike the peripheral organ systems, the CNS lacked a clearly defined lymphatic vasculature and waste clearance mechanism. However, in 2015, the meningeal lymphatic system (MLS) was first visualized in the dura of humans (1). Since then, a number of studies have investigated the MLS’s potential impact on various neurological diseases, including Alzheimer’s, Parkinson’s, Multiple Sclerosis, hydrocephalus, and epilepsy (2‐6). Other studies have also demonstrated the MLS’s profound influence on stroke (7‐10). However, there is little research that characterizes MLS imaging biomarkers in relation to stroke. Our study evaluates currently proposed MLS MRI biomarkers in large vessel occlusion stroke treated with thrombectomy. Methods : Participants: We recruited twenty patients who had an acute ischemic stroke treated with mechanical thrombectomy (MT) in a large intracranial artery (middle cerebral artery, internal carotid artery, basilar and/or vertebral). The mean age of our population was 69.9 ± 15.5 years. 12 (60%) of our patients had been treated with a combined approach stentriever + aspiration catheter, 4 (20%) with stentriever only, and 4 (20%) with contact aspiration only. Study Design: Basic demographic data, clinical comorbidities, information related to the stroke, technical details about the MT and outcome were collected from electronic medical records. We implemented High Resolution MR Vessel Wall Imaging (HR‐VWI) with a black blood T1‐weighted sequence to characterize changes in the enhancing vessels around the superior sagittal sinus that have been described as potential markers for meningeal lymphatic vessels (1). Within 24 hours after the MT procedure, patients underwent a 45‐minute 3T‐ brain MRI with contrast using a 20‐channel head coil (MAGNETOM Skyra, Siemens) with a sagittal isotropic black blood sequence included with the standard protocol. Our field of view included the superior sagittal sinus. Coronal reconstructed pre‐and post‐contrast back blood T1 sequences were qualitatively evaluated by a board certified Neuroradiologist with 8 years of academic experience evaluating the cerebrovasculature for the presence of purported meningeal lymphatic prominence or asymmetry. Results : There was no significant prominence or asymmetric difference seen in the purported meningeal lymphatics based on 3D high‐resolution T1 black blood MRI sequences in acute stroke large vessel occlusion post‐MT subjects. Conclusions : While in our study no observable differences were seen in the purported meningeal lymphatics based on current MR techniques, it marks an important initial step in development of a useful biomarker for the CNS lymphatic system. Future studies are needed to evaluate alternative meningeal lymphatic quantitative biomarkers. Our study also highlights the need for improved standardization of biomarkers for the meningeal lymphatics. By continuing to evaluate imaging biomarkers, we can further understand the MLS’s potentially profound role in complex neurological diseases. </jats:p

Abstract 1122‐000183: Assessing Meningeal Lymphatic MRI Biomarkers in Acute Large Vessel Occlusion Stroke Treated with Thrombectomy

Introduction: Until recently, there was very little known about the brain’s waste removal system. Unlike the peripheral organ systems, the CNS lacked a clearly defined lymphatic vasculature and waste clearance mechanism. However, in 2015, the meningeal lymphatic system (MLS) was first visualized in the dura of humans (1). Since then, a number of studies have investigated the MLS’s potential impact on various neurological diseases, including Alzheimer’s, Parkinson’s, Multiple Sclerosis, hydrocephalus, and epilepsy (2‐6). Other studies have also demonstrated the MLS’s profound influence on stroke (7‐10). However, there is little research that characterizes MLS imaging biomarkers in relation to stroke. Our study evaluates currently proposed MLS MRI biomarkers in large vessel occlusion stroke treated with thrombectomy. Methods: Participants: We recruited twenty patients who had an acute ischemic stroke treated with mechanical thrombectomy (MT) in a large intracranial artery (middle cerebral artery, internal carotid artery, basilar and/or vertebral). The mean age of our population was 69.9 ± 15.5 years. 12 (60%) of our patients had been treated with a combined approach stentriever + aspiration catheter, 4 (20%) with stentriever only, and 4 (20%) with contact aspiration only. Study Design: Basic demographic data, clinical comorbidities, information related to the stroke, technical details about the MT and outcome were collected from electronic medical records. We implemented High Resolution MR Vessel Wall Imaging (HR‐VWI) with a black blood T1‐weighted sequence to characterize changes in the enhancing vessels around the superior sagittal sinus that have been described as potential markers for meningeal lymphatic vessels (1). Within 24 hours after the MT procedure, patients underwent a 45‐minute 3T‐ brain MRI with contrast using a 20‐channel head coil (MAGNETOM Skyra, Siemens) with a sagittal isotropic black blood sequence included with the standard protocol. Our field of view included the superior sagittal sinus. Coronal reconstructed pre‐and post‐contrast back blood T1 sequences were qualitatively evaluated by a board certified Neuroradiologist with 8 years of academic experience evaluating the cerebrovasculature for the presence of purported meningeal lymphatic prominence or asymmetry. Results: There was no significant prominence or asymmetric difference seen in the purported meningeal lymphatics based on 3D high‐resolution T1 black blood MRI sequences in acute stroke large vessel occlusion post‐MT subjects. Conclusions: While in our study no observable differences were seen in the purported meningeal lymphatics based on current MR techniques, it marks an important initial step in development of a useful biomarker for the CNS lymphatic system. Future studies are needed to evaluate alternative meningeal lymphatic quantitative biomarkers. Our study also highlights the need for improved standardization of biomarkers for the meningeal lymphatics. By continuing to evaluate imaging biomarkers, we can further understand the MLS’s potentially profound role in complex neurological diseases

Endovascular Considerations in Traumatic Injury of the Carotid and Vertebral Arteries

AbstractCervical carotid and vertebral artery traumatic injuries can have a devastating natural history. This article reviews the epidemiology, mechanisms of injury, clinical presentation, and classification systems pertinent to consideration of endovascular treatment. The growing role of modern endovascular techniques for the treatment of these diseases is presented to equip endovascular surgeons with a framework for critically assessing patients presenting with traumatic cervical cerebrovascular injury.</jats:p

Abstract 1: Galectins in glioblastoma: opportunities for combined therapy

Abstract Background: Despite aggressive treatment, including surgical resection, radiation and chemotherapy, over 90% of glioblastoma (GB) patients experience tumor recurrence. This may be due to high migratory potential, angiogenesis, molecular heterogeneity and a strong immunosuppressive environment. GB expresses high levels of carbohydrate-binding galectin proteins and histone deacetylase (HDAC) activity. The aim of this study was: 1) identify the differential expressions of galectin 1-15 protein levels in human GB patient samples as compared to normal tissue (obtained from Institutional Tissue Bank) and (2) modulate the galectin functions with and without a HDAC inhibitor (DATS: Dially Triisulfide and SAHA: Suberoylanilide Hydroxamic Acid ) or bevacizumab in in vitro GB models. Methods: The effects of TMZ, ionizing radiation, or combined chemoradiation on galectin protein secretion and expression were assessed in human GB cells and human umbilical vein endothelial cells (HUVECs). Results: We found increased galectin-1 protein expression in human GB tissue. We also observed that HUVEC co-culture with GB cells increased galectin-1 protein expression by 14 - 20% following bevacizumab, and conferred a bevacizumab protective benefit to GB cells. Our in vitro models promisingly demonstrated that 72 hr treatments with 25 µM of galectin 1 inhibitor + HDAC inhibitor induce antitumor activity in GB cells. Western blot and activities assay results also demonstrated that combination blockade of HDAC activity and galectin-1 augmented apoptosis in GB cells, which mechanistically involves activation of caspase-3 and inhibition of anti-apoptotic protein (survivin, p-Akt, and Mcl-1 expression). Conclusion: Our in vitro culture results suggest possible benefit in combining a galectin inhibitor with an HDAC inhibitor in GB. Further studies in different animal models are warranted. Citation Format: David Cachia, Arindam Rano Chatterjee, William Alexander Vandergrift, Sunil J. Patel, Gabriel A. Rabinovich, Arabinda Das. Galectins in glioblastoma: opportunities for combined therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1. doi:10.1158/1538-7445.AM2017-1</jats:p