Success Rate Of Deployment Research Articles

Deep reinforcement learning based resource provisioning for federated edge learning

With the rapid development of mobile internet technology and increasing concerns over data privacy, Federated Learning (FL) has emerged as a significant framework for training machine learning models. Given the advancements in technology, User Equipment (UE) can now process multiple computing tasks simultaneously, and since UEs can have multiple data sources that are suitable for various FL tasks, multiple tasks FL could be a promising way to respond to different application requests at the same time. However, running multiple FL tasks simultaneously could lead to a strain on the device’s computation resource and excessive energy consumption, especially the issue of energy consumption challenge. Due to factors such as limited battery capacity and device heterogeneity, UE may fail to efficiently complete the local training task, and some of them may become stragglers with high-quality data. Aiming at alleviating the energy consumption challenge in a multi-task FL environment, we design an automatic Multi-Task FL Deployment (MFLD) algorithm to reach the local balancing and energy consumption goals. The MFLD algorithm leverages Deep Reinforcement Learning (DRL) techniques to automatically select UEs and allocate the computation resources according to the task requirement. Extensive experiments validate our proposed approach and showed significant improvements in task deployment success rate and energy consumption cost.

Multi-objective optimization of SFC deployment using service aggregation and computing offload

New technologies such as virtualization and Software Defined Networking (SDN) have given traditional networks unprecedented flexibility. A Service Function Chain (SFC) formed by concatenating multiple Virtual Network Functions (VNFs) expands network functions to meet the growing personalized network requirements of applications. However, due to the decentralization of VNF instances and the tight cloud load, how to ensure Quality of Service (Qos) while deploying the SFC brings new challenges. Hence, a SFC deployment strategy based on multi-objective optimization, named MO-SACO is proposed, which regards delay optimization, reliability assurance and cost reduction as the main objectives. Specifically, we first design a VNF aggregation rule to handle raw SFC requests, which effectively reduces the SFC path latency and improves reliability. Then, VNF placement and traffic routing is modeled as a computation offloading decision based on cloud-fog-edge collaboration with the goal of target optimization according to functional, location, and resource constraints. Finally, we also take into account the performance changes of deployed SFCs and handle non-compliant requests in a timely manner. We conduct extensive simulations in networks of varying sizes and the results demonstrate that the proposed MO-SACO strategy not only achieves lower latency and cost, higher reliability compared with the state-of-the-art methods, but also has unexpected performance in terms of the deployment success rate and node load.

Safety and efficacy of second-generation all-suture anchors in labral tear arthroscopic repairs: prospective, multicenter, 1-year follow-up study

BackgroundThis study’s primary aim was to assess the safety and performance of second-generation all-soft suture anchors following arthroscopic labral tear repair. MethodsThis prospective, multicenter study was conducted by 6 surgeons at 6 sites in Europe and the United States between November 2018 and August 2020. Patients who required shoulder arthroscopic repair, for a range of labral injuries, were treated with a second-generation all-soft suture anchor. The primary outcome was clinical success rate (percentage of patients without signs of failure and/or re-intervention) at 6 months. Secondary outcomes included clinical success rate at 12 months, intraoperative anchor deployment success rate, and patient-reported outcomes (PROs) at 6 and 12 months, including visual analog scale (VAS) pain assessment, VAS satisfaction assessment, EQ-5D-5L Index Score, EQ-5D-5L VAS Health Score, Rowe Shoulder Score for Instability, American Shoulder and Elbow Surgeons score, and Constant-Murley Shoulder (CMS) Score. Serious adverse events (SAE) and serious adverse device effects (SADE) were collected throughout the study. ResultsForty-one patients were enrolled (mean age, 28.2 years; 87.8% male, 12.2% female). Clinical success was achieved in 27/28 and 31/32 patients at 6 months and 12 months, respectively. Anchor deployment had a 100% success rate. Significant improvements over baseline were reported for all PROs except CMS (6 months) and VAS Satisfaction Score (12 months). One patient experienced 1 SAE and 1 patient experienced 1 SADE. ConclusionSecond-generation all-soft suture anchors used in this study demonstrated a high clinical success rate, a favorable safety profile, and patients exhibited significant improvement in PROs.

Digital twin-assisted service function chaining in multi-domain computing power networks with multi-agent reinforcement learning

The emerging computing power network (CPN) is believed to undergo the paradigm reformation of network function virtualization (NFV) and service function chaining (SFC). It is prerequisite to explore the performance upper bound of NFV-assisted CPN before truly deploying the NFV and SFC technologies onto physical networks. Inspired by the application of digital twin (DT) in the industry and due to its advantage in synchronizing physical objects with their virtual replicas, we propose to use the DT to assist the SFC deployment in the multi-domain CPN, with the aid of multi-agent deep deterministic policy gradient (MADDPG) framework. First, we build a dynamic SFC mapping problem in the virtual twin network layer, by modeling the computing power, link bandwidth, delay performance and the VNF ordering as DT objects and constraints, to jointly optimize the energy consumption, end-to-end delay and the VNF re-deploying cost. Then, the prioritized experience replay and re-parameterization trick-empowered centralized training and decentralized execution MADDPG framework is utilized to learn the SFC deployment, by taking each domain controller as one agent. Finally, numerical experiments are carried out to validate the effectiveness of MADDPG in the cross-domain SFC deployment. For performance verification, the deployment success rate, number of crossed domains, energy consumption, end-to-end latency and load balancing degree are all taken as metrics, to show the performance of MADDPG compared to other learning frameworks.

Does Small Aneurysm Size (

Long-term safety and efficacy outcomes of Surpass Evolve flow diverter (SEFD) in treatment of intracranial aneurysms are lacking. Factors predicting complete aneurysm occlusion are elusive in literature. A retrospective review of all consecutive aneurysms treated with SEFD from February 2020 to July 2022, at a single comprehensive stroke center. Fifty-one patients with 80 aneurysms were included. Mean target aneurysm size was 5.6 mm and mean neck-width 3.42 mm. Small aneurysms (<10 mm) were 75% (n=60), while 25% were >10 mm. Unruptured were 71 (88.7%), previously ruptured were 8 (10%), and partially thrombosed 2.3% (n=1). Mean SEFDs used per patient were 1.07 and 40% (n=22) procedures were performed transradially. Mean procedure time was 59.1 minutes. The technical success rate for device deployment was 100%. Raymond Roy (RR) class I occlusion at 6 month (n=73) was seen among 56.2% (n=41), at 1 year (n=35) among 85.7% (n=30) and at 2 year (n=18) among 88.8% (n=16) aneurysms. Aneurysm size <10 mm significantly predicted RR-I occlusion outcome (odds ratio [OR]: 2.16; confidence interval [CI]: 0.02-4.29) at 6 months. Age, gender, smoking status, hypertension, location of aneurysm, and rupture status did not predict RR-I occlusion outcome. No mortality or permanent neurological morbidity was observed in the cohort. Major complications seen in 7.2% (n=4) patients were stent thrombosis (n=1, 1.8%), carotid-cavernous fistula (n=1, 1.8%) and transient ischemia in 2 (3.6%). Non-flow limiting stenosis was observed in 3 (5.4%) patients. SEFD gives good aneurysm occlusion rates with favorable long-term safety profile and low rate of thromboembolic complications. Small aneurysm size (<10 mm) was associated with complete aneurysm occlusion at 6-month angiographic follow-up. As Surpass Evolve is a newer generation Flow diverter of the Stryker Surpass FDs, with its improved design and applicability in intracranial aneurysms, we believe that more physicians will be encouraged to use this device worldwide.

Clinical comparative analysis of 3D printing-assisted extracorporeal pre-fenestration and Castor integrated branch stent techniques in treating type B aortic dissections with inadequate proximal landing zones

BackgroundThis study aims to compare the clinical effects of two distinct surgical approaches, namely 3D printing-assisted extracorporeal pre-fenestration and Castor integrated branch stent techniques, in treating patients with Stanford type B aortic dissections (TBAD) characterized by inadequate proximal landing zones.MethodsA retrospective analysis was conducted on 84 patients with type B aortic dissection (TBAD) who underwent thoracic endovascular aortic repair (TEVAR) with left subclavian artery (LSA) reconstruction at our center from January 2022 to July 2023. Based on the different surgical approaches, the patients were divided into two groups: the group assisted by 3D printing for extracorporeal pre-fenestration (n = 44) and the group using the castor integrated branch stent (n = 40). Clinical indicators: including general patient information, operative time, surgical success rate, intraoperative and postoperative complication rates, re-intervention rate, and mortality, as well as postoperative aortic remodeling, were compared between the two groups. The endpoint of this study is the post-TEVAR mortality rate in patients.ResultsThe surgical success rate and device deployment success rate were 100% in both groups, with no statistically significant difference (P > 0.05). However, the group assisted by 3D printing for extracorporeal pre-fenestration had a significantly longer operative time (184.20 ± 54.857 min) compared to the group using the castor integrated branch stent (152.75 ± 33.068 min), with a statistically significant difference (t = 3.215, p = 0.002, P < 0.05). Moreover, the incidence of postoperative cerebral infarction and beak sign was significantly lower in the group assisted by 3D printing for extracorporeal pre-fenestration compared to the castor-integrated branch stent group, demonstrating statistical significance. There were no significant differences between the two groups in terms of other postoperative complication rates and aortic remodeling (P > 0.05). Notably, computed tomography angiography images revealed the expansion of the vascular true lumen and the reduction of the false lumen at three specified levels of the thoracic aorta. The follow-up duration did not show any statistically significant difference between the two groups (10.59 ± 4.52 vs. 9.08 ± 4.35 months, t = 1.561, p = 0.122 > 0.05). Throughout the follow-up period, neither group experienced new endoleaks, spinal cord injuries, nor limb ischemia. In the castor-integrated branch stent group, one patient developed a new distal dissection, prompting further follow-up. Additionally, there was one case of mortality due to COVID-19 in each group. There were no statistically significant differences between the two groups in terms of re-intervention rate and survival rate (P > 0.05).ConclusionBoth 3D printing-assisted extracorporeal pre-fenestration TEVAR and castor-integrated branch stent techniques demonstrate good safety and efficacy in treating Stanford type B aortic dissection with inadequate proximal anchoring. The 3D printing-assisted extracorporeal pre-fenestration TEVAR technique has a lower incidence of postoperative cerebral infarction and beak sign, while the castor-integrated branch stent technique has advantages in operative time.

Vanguard Study: Initial experience with the new fourth generation Pipeline Vantage Flow Diverter (PVFD): 6-month results, technical and clinical considerations

BackgroundThe Pipeline Embolization Device has proven to be a safe and effective device for the treatment of intracranial aneurysms. The Pipeline Vantage Flow Diverter (PVFD) with Shield Technology is the...

Percutaneous Coronary Intervention in Patients with Coronary Artery Ectasia: A Retrospective Single-center Study.

This retrospective single-center study aimed to compare the outcomes of ad-hoc versus planned percutaneous coronary intervention (PCI) in patients with coronary ectasia. We investigated baseline characteristics, primary and secondary outcomes, and predictors of mortality in a cohort of patients who underwent PCI procedures. Data from 3,179 patients (ad-hoc PCI, n = 1,286; planned PCI, n = 1,893) with coronary ectasia were analyzed. Baseline characteristics, including age, gender, comorbidities, and lesion characteristics, were compared between the two groups. Primary outcomes included technical success and stent deployment success, while secondary outcomes encompassed major adverse cardiovascular events (MACE), all-cause mortality, recurrent angina, and target lesion revascularization. Logistic regression was utilized to identify predictors of mortality. The ad-hoc PCI group exhibited a higher prevalence of comorbidities, including hypertension, diabetes mellitus, smoking history, and multi-vessel disease (all p < 0.05). While technical success and stent deployment success rates were lower in the ad-hoc PCI group (p < 0.05), patients undergoing planned PCI demonstrated significantly lower rates of MACE, all-cause mortality, recurrent angina, and target lesion revascularization (all p < 0.05). Logistic regression analysis identified older age, male gender, hypertension, diabetes mellitus, smoking history, and multi-vessel disease as independent predictors of mortality (all p < 0.05). Importantly, coronary ectasia emerged as an additional predictor of mortality (p = 0.002). Our study indicates that planned PCI is associated with improved procedural outcomes and lower rates of mortality and adverse events compared to ad-hoc PCI in patients with coronary ectasia.

The novel technique of drainage stenting using a tapered sheath dilator in endoscopic ultrasound-guided biliary drainage.

During endoscopic ultrasound-guided biliary drainage (EUS-BD), there is a risk for bile leakage until stent deployment, which can result in severe peritonitis, particularly when passing a drainage stent becomes challenging despite tract dilation. There is no established method or dedicated device to optimize EUS-BD. Therefore, we have developed a novel stent deployment technique using the tapered sheath dilator. To address the safety and technical aspects of the EUS-BD technique, we retrospectively analyzed 11 consecutive patients who underwent EUS-BD using the tapered sheath dilator. The procedure involved the insertion of a guidewire, followed by mechanical dilation using the tapered sheath dilator. Subsequently, the inner catheter was removed and drainage stents (up to 6 Fr in diameter) were deployed through the outer sheath. We found a 100% technical success rate for tract dilation and stent deployment; moreover, all patients achieved clinical success. The median time for dilation was 40 s (range, 8-198), whereas the median time from dilation to stent deployment was 10 min (range, 6-19). Notably, no cases of bile leakage or peritonitis were observed. In conclusion, the use of the integrated device for tract dilation and stent delivery system might provide a safe and straightforward technique for drainage stenting during EUS-BD.

1040 Impact of Common Femoral Artery Calcification on the Comparative Efficacy of Vascular Closure Device Deployments Following Large Bore Vascular Access

Abstract Introduction The suture-mediated ProGlide and more recently, the plug-based MANTA are commonly used vascular closure devices (VCDs) for large-bore vascular access haemostasis, though both devices operate differently. The site and extent of the common femoral artery (CFA) calcification are significant determinants of the choice of VCD. Anterior calcification may hamper ProGlide deployments, while posterior calcification may represent a similar consideration for the MANTA. Method A retrospective analysis of procedures with large-bore CFA access from 2017 to 2022 was undertaken. The access sites are grouped as Group A (Proglide) and Group B (MANTA). Calcification graded as (0 = none, 1 = Anterior, 2 = Posterior and 3 = Anterior &amp; Posterior) on preoperative CTA along 10mm segments with 0.625mm slice thickness. Minitabv21 was used for Statistical analysis, particularly analysing the correlation of calcification to VCD deployment success rates. Results We assessed 207 endovascular procedures with 374 large-bore accesses (243 Group A, 127 Group B). The mean age was 74.9±8 (183 males), the average BMI was 28±5.8 (44 diabetics), and 180 (86.9%) were smokers. Grade 1 Calcification was 1.8%, Grade 2, 49% (120 Group A, 63 Group B) and Grade 2, 14.3% (31 Group A, 22 Group B). Successful deployment was achieved in 91% (337 groins, p = 0.86). The correlation of calcification with successful deployment was not significant p = 0.33. Conclusions Posterior calcification was more common in both groups. The site of calcification did not impact the efficacy of the closure device. All our percutaneous accesses were ultrasound-guided, we concluded it can improve the effectiveness of VCD, avoiding calcification.

EOR technologies for fractured-vuggy carbonate condensate gas reservoirs

There are abundant marine carbonate rock resources in China, which are dominated by fractured-vuggy carbonate oil and gas reservoirs accounting for over two thirds of proved reserves. The fractured-vuggy carbonate condensate gas reservoir in the Tarim Basin is at a burial depth of 4500–7000 m with the characteristics of extremely strong reservoir heterogeneity, complicated and diverse reservoir seepage media, complex fluid properties and quite difficult static characterization, which brings many challenges to reserve evaluation, development plan design and performance analysis. In order to improve the recovery factor of this type of oil and gas reservoir, this paper takes the dynamic characterization to supplement the static characterization and combines each other to improve the accuracy. In addition, based on many years' of dynamic and static research and development practice, the key enhanced gas recovery (EGR) technologies for fractured-vuggy carbonate condensate gas reservoirs are innovatively developed, such as the high-accuracy dynamic characterization technology with dynamic and static iteration for fractured-vuggy body in the strongly attenuated area of desert by taking seismic inversion information as the basis and 3D numerical well test as the core, the multi-target 3D development technology in one well to improve reserve production of fractured-vuggy condensate gas reservoirs, and the gas-lift depressurization EGR technology for fractured-vuggy condensate gas reservoirs. In conclusion, this technological system better solves the key difficulties in the fine characterization of fractured-vuggy body, reserve production improvement and abandonment pressure reduction of well. What's more, it realizes the fine reservoir characterization of fractured zones and feather-shaped fractured zones and the accurate prediction of key development indexes, and increases the deployment success rate of effective wells and efficient wells by 26% compared with that in the initial stage of large-scale productivity construction. To sum up, these technologies provide powerful technical support and reference experience for the scientific and efficient development of fractured-vuggy carbonate condensate gas reservoirs.

Charger and receiver deployment for trajectory coverage with delay constraint in mobile wireless rechargeable sensor networks

Wireless Rechargeable Sensor Networks (WRSNs) powered by radio-frequency radiation attract a lot of attention for their sustainability and convenience, etc. One focus is how to rationally deploy the key devices, such as receiver and charger, to improve the network performance and deployment budget. This paper considers a novel deployment problem for WRSNs in a two-dimensional space with static trajectories, deploying the minimum number of wireless chargers and receivers for mobile nodes, subject to the non-overtime updating probability requirement for mobile node at any location of the trajectories. This timeliness communication problem is tricky and NP-hard when involving the influence of three practical delays (retransmission delay, charging delay and competition delay). Therefore, a performance controllable discretization strategy is proposed, based on which the Greedy Heuristic (GH) and Particle Swarm Optimization (PSO) based approximate solutions are introduced. The execution process and time complexity of these two solutions are analyzed, and then the numerical results of extensive simulations are introduced to verified the scalability, accuracy and efficiency of the two solutions. As a result, the GH solution has better deployment success rate and efficiency, and is the recommended solution for the novel problem. Finally, two real-life scenarios (indoor exhibition hall and hospital interior road) are introduced to further verify the robustness of the two solutions under the practical challenges of uneven density of mobile nodes, restricted deployment locations and occlusion of wireless links.

Braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in patients with unruptured complex intracranial aneurysms

PurposesBraided and laser-cut stents both are efficacious and safe for coiling intracranial aneurysms. The study aimed to compare outcomes following braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in 266 patients who were diagnosed with unruptured intracranial aneurysms of different types and locations. MethodsPatients with unruptured complex intracranial aneurysms underwent braided (BSE cohort, n = 125) or laser engraved (LSE cohort, n = 141) stent-assisted embolization. ResultsThe deployment success rate was higher for patients of the LSE cohort than those of the BSE cohort (140 [99%] vs. 117 [94%], p = 0.0142). Seventy-one (fifty-seven percentages) and 73 (52%) were coil embolization procedure success rates of the BSE and the LSE cohorts. Periprocedural intracranial hemorrhage was higher in patients of the BSE cohort than those of the LSE cohort (8 [6%] vs. 1 [1%], p = 0.0142). Four (three percentages) patients from the LSE cohort and 3 (2%) patients from the BSE cohort had in-stent thrombosis during embolization. Permanent morbidities were higher in patients of the LSE cohort than those of the BSE cohort (8 [6%] vs. 1 [1%], p = 0.0389). Higher successful procedures (76% vs. 68%) and fewer postprocedural intracranial hemorrhage (0% vs. 5%) and mortality (0% vs. 5%) were reported for patients of the BSE cohort in posterior circulation aneurysmal location than those of the LSE cohort. Laser engraved stent has fewer problems with deployment and may have better periprocedural and follow-up outcomes after embolization. ConclusionsBraided stent-assisted embolization should be preferred when the aneurysm is present in the posterior circulation.

Quality 4.0 – an evolution of Six Sigma DMAIC

Purpose Manufacturing companies can competitively be recognized among the most advanced and influential companies in the world by successfully implementing Quality 4.0. However, its successful implementation poses one of the most relevant challenges to the Industry 4.0. According to recent surveys, 80%–87% of data science projects never make it to production. Regardless of the low deployment success rate, more than 75% of investors are maintaining or increasing their investments in artificial intelligence (AI). To help quality decision-makers improve the current situation, this paper aims to review Process Monitoring for Quality (PMQ), a Quality 4.0 initiative, along with its practical and managerial implications. Furthermore, a real case study is presented to demonstrate its application. Design/methodology/approach The proposed Quality 4.0 initiative improves conventional quality control methods by monitoring a process and detecting defective items in real time. Defect detection is formulated as a binary classification problem. Using the same path of Six Sigma define, measure, analyze, improve, control, Quality 4.0-based innovation is guided by Identify, Acsensorize, Discover, Learn, Predict, Redesign and Relearn (IADLPR2) – an ad hoc seven-step problem-solving approach. Findings The IADLPR2 approach has the ability to identify and solve engineering intractable problems using AI. This is especially intriguing because numerous quality-driven manufacturing decision-makers consistently cite difficulties in developing a business vision for this technology. Practical implications From the proposed method, quality-driven decision-makers will learn how to launch a Quality 4.0 initiative, while quality-driven engineers will learn how to systematically solve intractable problems through AI. Originality/value An anthology of the own projects enables the presentation of a comprehensive Quality 4.0 initiative and reports the approach’s first case study IADLPR2. Each of the steps is used to solve a real General Motors’ case study.

Multicenter Study for the Treatment of Sidewall versus Bifurcation Intracranial Aneurysms with Use of Woven EndoBridge (WEB)

Background The Woven EndoBridge (WEB) device was explicitly designed for wide-neck intracranial bifurcation aneurysms. Small-scale reports have evaluated the off-label use of WEB devices for the treatment of sidewall aneurysms, with promising outcomes. Purpose To compare the angiographic and clinical outcomes of the WEB device for the treatment of sidewall aneurysms compared with the treatment of bifurcation aneurysms. Materials and Methods A retrospective review of the WorldWideWEB Consortium, a synthesis of retrospective databases spanning from January 2011 to June 2021 at 22 academic institutions in North America, South America, and Europe, was performed to identify patients with intracranial aneurysms treated with the WEB device. Characteristics and outcomes were compared between bifurcation and sidewall aneurysms. Propensity score matching (PSM) was used to match by age, pretreatment ordinal modified Rankin Scale score, ruptured aneurysms, location of aneurysm, multiple aneurysms, prior treatment, neck, height, dome width, daughter sac, and incorporated branch. Results A total of 683 intracranial aneurysms were treated using the WEB device in 671 patients (median age, 61 years [IQR, 53-68 years]; male-to-female ratio, 1:2.5). Of those, 572 were bifurcation aneurysms and 111 were sidewall aneurysms. PSM was performed, resulting in 91 bifurcation and sidewall aneurysms pairs. No significant difference was observed in occlusion status at last follow-up, deployment success, or complication rates between the two groups. Conclusion No significantly different outcomes were observed following the off-label use of the Woven EndoBridge, or WEB, device for treatment of sidewall aneurysms compared with bifurcation aneurysms. The correct characterization of the sidewall aneurysm location, neck angle, and size is crucial for successful treatment and lower retreatment rate. © RSNA, 2022 See also the editorial by Hetts in this issue.

Feasibility and Efficacy of Low-profile Visual Intraluminal Support Device: A Single Center Five-year Experience.

The Low-Profile Visualized Intraluminal Support (LVIS) devices are a new generation of self-expandable, high-porosity stents approved for the treatment of large to giant wide-necked intracranial aneurysms via stent-assisted coiling. Here we report the radiographic and clinical outcomes seen with LVIS, LVIS Jr. and LVIS Blue from a single institution over a fiveyear period. Patients with intracranial aneurysms treated by LVIS, LVIS Jr. and LVIS Blue technology over a five-year period (2012 - 2017) at our institution were retrospectively reviewed. Seventy-four patients (55 females and 19 males; average age = 59.2) with 74 aneurysms underwent embolization of intracranial aneurysms using LVIS (N = 10), LVIS Jr. (N = 47) or LVIS Blue (N = 12) devices at our institution over the study period. The most common location of treated aneurysms was the anterior communicating artery (31%), followed by the basilar artery (19%), and the middle cerebral artery (13%). The mean neck and dome sizes were 3.9±1.5mm and 6.6±3.2mm, respectively. The median follow-up time was 6 months. At the last radiographic follow- up, 93.1% of patients had complete occlusion (RR-I or OKM-D). In 5 cases (7%), the LVIS stent failed to open, requiring balloon angioplasty (N = 3) or stent recapture and use of a non-LVIS branded device (N = 2). Five patients had post-embolization infarcts, and 1 patient had an intra-operative dome rupture. LVIS brand of stents is a safe, effective, and technically feasible treatment strategy for wide-neck intracranial aneurysms, with high deployment success and aneurysm obliteration rates.

Efficacy and Safety of Ultrasound-Guided Repeat Access and Repeat Closure With an ExoSeal Vascular Closure System in Patients With Peripheral Arterial Disease.

The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided repeat access and repeat closure with an ExoSeal vascular closure system. A total of 123 endovascular therapy (EVT) procedures were performed in 59 patients (65 limbs) with ultrasound-guided repeat access and repeat implantation of an ExoSeal vascular closure system between January 2019 and March 2021. The procedural details and postprocedural outcomes of EVT with repeat access and use of ExoSeal (RE group) were compared with those of EVT with initial use of ExoSeal (IE group) in the same patients. In a subgroup analysis, these outcomes were also compared in early repeat (within 3months) and late repeat (over 3months) cases. The technical success rate of ultrasound-guided access in the RE group was 100%. The procedural success rate of EVT and deployment success rate of ExoSeal in the RE group were 93% and 94%, respectively, which were not significantly different to those in the IE group. Access site complications in the RE group occurred in 2 cases (2%), again with no significant difference with the IE group. The median puncture, procedural, and hemostasis times in the RE group were 3 [2-5], 36.5 [29-54], and 7 [5-10] min, respectively, which were not significantly longer than those in the IE group. In the RE group, early and late repeat closure was performed in 66 (54%) and 57 (46%) cases, respectively, and there were no significant differences in the technical success of ultrasound-guided access, procedural success of EVT, deployment success of ExoSeal, and access site complication rates in these cases. Ultrasound-guided access facilitated higher technical success of repeat access and fewer access site complications in EVT with repeat use of ExoSeal, regardless of the interval between procedures.

Post-Trial Enhanced Deployment and Technical Performance with the MISTIE Procedure per Lessons Learned

ObjectiveWe hypothesize that procedure deployment rates and technical performance with minimally invasive surgery and thrombolysis for intracerebral hemorrhage (ICH) evacuation (MISTIE) can be enhanced in post-trial clinical practice, per Phase III trial results and lessons learned. Materials and MethodsWe identified ICH patients and those who underwent MISTIE procedure between 2017–2021 at a single site, after completed enrollments in the Phase III trial. Deployment rates, complications and technical outcomes were compared to those observed in the trial. Initial and final hematoma volume were compared between site measurements using ABC/2, MISTIE trial reading center utilizing manual segmentation, and a novel Artificial Intelligence (AI) based volume assessment. ResultsNineteen of 286 patients were eligible for MISTIE. All 19 received the procedure (6.6% enrollment to screening rate 6.6% compared to 1.6% at our center in the trial; p=0.0018). Sixteen patients (84%) achieved evaculation target < 15 mL residual ICH or > 70% removal, compared to 59.7% in the trial surgical cohort (p=0.034). No poor catheter placement occurred and no surgical protocol deviations. Limitations of ICH volume assessments using the ABC/2 method were shown, while AI based methodology of ICH volume assessments had excellent correlation with manual segmentation by experienced reading centers. ConclusionsGreater procedure deployment and higher technical success rates can be achieved in post-trial clinical practice than in the MISTIE III trial. AI based measurements can be deployed to enhance clinician estimated ICH volume. Clinical outcome implications of this enhanced technical performance cannot be surmised, and will need assessment in future trials.

Analysis ofpredictiveandpreventivefactorsfor access complications associated with vascular closure devices in complicated endovascular procedures.

The main goal is to evaluate the effectiveness of angioseal and starclose vascular closure devices (VCDs) in high-risk patients under intensive anticoagulation who require therapeutic angiographic procedures and to discuss which factors are important in complications associated with VCDs. Medical records of the patients who underwent therapeutic complex interventional vascular procedures were reviewed retrospectively. One hundred sixty-six patients were divided into two groups regarding VCDs used for access-site closure after the procedure: group 1, (angioseal); group 2, (starclose). Data including patients' demographics and comorbidity information, procedural characteristics, and complications were analyzed. The device deployment success rate was 100%. For the procedural characteristics, there was no significant difference between the groups except access site (P = 0.016) and sheath size > 6F (P = 0.0001). No major complications had occurred in none of the patients. Minor complications including hematoma, access-site pain, and access-site infection, except prolonged hemostasis did not differ significantly between groups. The patients' demographic and periprocedural factors were not significantly correlated with the development of complications. Contrary to published reports, our study showed that demographic and periprocedural factors may not be responsible for the vascular access-site complications associated with VCDs.

Creation of an ex-vivo bovine kidney flow model for testing embolic agents: work in progress

ObjectivesTo develop an ex- vivo perfusion flow model using a bovine kidney for future testing of embolic agents in an inexpensive and easy way.MethodsSix bovine adult kidneys were used for this study. Kidneys were cannulated and perfused via a roller pump. Three embolic agents, coils, Gelfoam, and a glue mixture of Histoacryl + Lipiodol, were deployed by targeting three secondary segmental arteries per kidney via a 5Fr catheter under fluoroscopic guidance. Cannulation time, success rate of segmental artery selection and embolic agent deployment, total operational time, and fluoroscopy dose were recorded.ResultsAverage kidney weight was 0.752 +/− 0.094 kg. All six bovine kidneys were successfully cannulated in 21.6 min +/− 3.0 min. Deployment of coils and glue was achieved in every case (12/12); however, Gelfoam injection was not successful in one instance (5/6, 83%). Coil deployment demonstrated no embolic effect while Gelfoam and glue injections demonstrated decreased distal contrast filling post-embolization. Mean dose area product was 12.9 ± 1.8 Gy·cm2, fluoroscopy time was 10 ± 4 min and operational time was 27 ± 8 min.ConclusionsWe describe the creation of an ex vivo bovine kidney flow model for the preclinical evaluation of different embolic materials. The flow model can be modified to provide extensive bench testing and it is a promising tool for hands -on training in basic and advanced embolization techniques .