Neurological Surgeons
11 years of experience
Video profile
Accepting new patients
Oregon Heart & Vascular Institute
3311 Riverbend Dr
Springfield, OR 97477
541-222-3531
Locations and availability (2)

Education ?

Medical School
Westfalische Wilhelms-Universitaet (1999)
Foreign school

Awards & Distinctions ?

Awards  
Patients' Choice Award (2011, 2013)
Compassionate Doctor Recognition (2011, 2013)
Associations
Congress of Neurological Surgeons

Affiliations ?

Dr. Hauck is affiliated with 9 hospitals.

Hospital Affilations

Score

Rankings

  • Sacred Heart Medical Center
    1255 Hilyard St, Eugene, OR 97401
    • Currently 4 of 4 crosses
    Top 25%
  • Cottage Grove Hospital
    1515 Village Dr, Cottage Grove, OR 97424
    • Currently 4 of 4 crosses
    Top 25%
  • Peace Harbor Hospital
    400 9th St, Florence, OR 97439
    • Currently 3 of 4 crosses
    Top 50%
  • McKenzie - Willamette Medical Center
    1460 G St, Springfield, OR 97477
    • Currently 2 of 4 crosses
  • St John's Medical Center
  • St. Joseph's Hospital
  • Peace Harbor Hospital 7/6/2010 Telemedicine Current Neurology
  • Sacred Heart Medical Center - Riverbend 1/6/2010 Active Current Neurosurgery
  • Sacred Heart Medical Center At Riverbend
    3333 Riverbend Dr, Springfield, OR 97477
  • Publications & Research

    Dr. Hauck has contributed to 33 publications.
    Title Salvage Neuroform Stent-assisted Coiling for Recurrent Giant Aneurysm After Waffle-cone Treatment.
    Date April 2012
    Journal Journal of Neurointerventional Surgery
    Excerpt

    We report a case of aneurysm progression after waffle-cone treatment. A patient in their seventies presented with headaches. Four years earlier, this individual had undergone waffle-cone treatment of a giant ruptured left ophthalmic aneurysm. Angiography demonstrated aneurysm growth. A second stent was deployed through the initially placed stent to recreate the aneurysm neck and to provide support for stent-assisted coiling. The residual aneurysm was coiled with good outcome.

    Title Stent-assisted Basilar Reconstruction for a Traumatic Vertebral Dissection with a Large Basilar Artery Thrombosis.
    Date April 2012
    Journal Journal of Neurointerventional Surgery
    Excerpt

    An individual in their 30s presented with quadriplegia and coma 7 h after a 30-foot free-fall. Angiography confirmed left vertebral artery dissection causing vertebral artery occlusion (thrombolysis in myocardial infarction (TIMI) 0) and basilar artery thrombosis. Deployment of six self-expanding intracranial stents (right P1 to left V3) resulted in recanalization (TIMI 3). Postoperative MRI demonstrated a large brainstem infarction; the patient was 'locked-in'. In the following 6 months, the patient recovered to ambulation and independence. Aggressive recanalization for symptomatic vertebrobasilar dissection/occlusion may be considered. Despite major diffusion-weighted imaging brainstem lesions, recovery is possible.

    Title The Balloon Anchor Technique: a Novel Technique for Distal Access Through a Giant Aneurysm.
    Date March 2012
    Journal Journal of Neurointerventional Surgery
    Excerpt

    A novel technique is reported that helps the operator in achieving reliable access to the distal parent vessel with a microcatheter for stent assisted aneurysm coiling. Distal parent vessel access was obtained by allowing the microwire to follow the local hemodynamics into a giant internal carotid artery aneurysm and around its dome. Various traditional methods were tried before attempting the balloon anchor. In this technique, an over-the-wire balloon was inflated in the distal vessel followed by gentle retraction of the balloon catheter and microwire allowed only a wire bridge across the aneurysm neck, thereby allowing the stent catheter to be brought up in a standard fashion. This technique may facilitate the use of new stent technologies for the treatment of aneurysms that would otherwise be untreatable with endovascular therapies.

    Title Endovascular Stent Therapy for Extracranial and Intracranial Carotid Artery Dissection: Single-center Experience.
    Date September 2011
    Journal Journal of Neurosurgery
    Excerpt

    The objective of this study was to evaluate endovascular stent therapy for carotid artery dissections (CADs).

    Title Prospective Acute Ischemic Stroke Outcomes After Endovascular Therapy: a Real-world Experience.
    Date July 2011
    Journal World Neurosurgery
    Excerpt

    To report results of endovascular therapy for acute ischemic stroke (AIS) in patients who were not candidates for intravenous thrombolysis (IVT) or in whom IVT failed.

    Title Complete Preoperative Embolization of Hemangioblastoma Vessels with Onyx 18.
    Date May 2011
    Journal Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
    Excerpt

    The authors present a preliminary experience with ethyl-enevinylalcohol copolymer (Onyx) for hemangioblastoma vessel embolization before surgical resection. The patient presented with neck pain, dizziness, blurred vision, vomiting, and loss of balance. Diagnostic imaging revealed a posterior fossa cystic mass with a nodular component. Angiography demonstrated a significant vascular blush with arteriovenous shunting that was characteristic of a hemangioblastoma. Tumor vessels originating off the left posterior inferior cerebellar artery were embolized before surgery using Onyx 18 (ev3, Covidien Vascular Therapies, Mansfield, MA, USA). This resulted in complete obliteration of all tumor vessels, transforming a highly vascular tumor into an avascular mass. A safe and uneventful surgical resection was performed the next day. Onyx is a valuable embolic agent for preoperative hemangioblastoma vessel embolization. Because of its low viscosity, Onyx penetrates deeply into the tumor vasculature and allows complete obliteration of tumor vessels. Risks of the intervention have to be carefully weighed against the benefits. If preoperative embolization is indicated, the use of Onyx should be strongly considered.

    Title Neurointerventional Procedures for Unruptured Intracranial Aneurysms Under Procedural Sedation and Local Anesthesia: a Large-volume, Single-center Experience.
    Date January 2011
    Journal Journal of Neurosurgery
    Excerpt

    In this paper, the authors' goal was to report the outcome of patients with unruptured intracranial aneurysms undergoing endovascular treatment under conscious sedation (local anesthesia).

    Title Direct Endovascular Recanalization of Chronic Carotid Occlusion: Should We Do It? Case Report.
    Date January 2011
    Journal Neurosurgery
    Excerpt

    BACKGROUND AND IMPORTANCE: Patients with chronic carotid artery occlusion face a significant risk of stroke. It is believed that treatment is indicated if medical therapy fails or even as prophylaxis in high-risk patients. Direct surgical repair with carotid endarterectomy has a considerable failure rate and significant associated risks. Indirect repair with an extracranial-to-intracranial bypass has become the mainstay of surgical treatment. In this case study, the authors assess the feasibility of direct endovascular recanalization in the setting of chronic carotid occlusion, and discuss technical nuances and indications in comparison with the world literature and alternative options.

    Title Endovascular Treatment of a Large Aneurysm Arising from a Basilar Trunk Fenestration Using the Waffle-cone Technique.
    Date December 2010
    Journal Neurosurgery
    Excerpt

    Endovascular treatment of large intracranial aneurysms arising from a fenestrated parent vessel may prove particularly difficult. We present a case of a large, broad-based aneurysm arising from a proximal basilar artery (BA) fenestration treated with the waffle-cone technique. Technical nuances and indications for this treatment option are reviewed.

    Title The Presigmoid Approach to Anterolateral Pontine Cavernomas. Clinical Article.
    Date October 2010
    Journal Journal of Neurosurgery
    Excerpt

    Anterolateral cavernomas of the pons have been surgically removed via a variety of approaches, commonly retrosigmoid or transventricular. The goal in this study was to evaluate the presigmoid approach as an alternative.

    Title The Small "surgical Aneurysm" at the Basilar Apex.
    Date June 2010
    Journal Journal of Neurosurgery
    Excerpt

    Because the risks are reduced, larger basilar apex aneurysms are usually treated endovascularly instead of with surgery. However, small basilar apex aneurysms are more common and an unfavorable shape may prevent definitive endovascular treatment. The goal of this study was to reevaluate the outcome of traditional surgery for small unruptured basilar apex aneurysms as an alternative to the currently more accepted endovascular treatment.

    Title Restenosis Rates Following Vertebral Artery Origin Stenting: Does Stent Type Make a Difference?
    Date June 2010
    Journal The Journal of Invasive Cardiology
    Excerpt

    To compare our experience with sirolimus and paclitaxel-eluting stents (drug-eluting stents [DES]) and non-drug-eluting stents (NDES) for treatment of vertebral artery (VA) origin stenosis and review the literature.

    Title Use of a Vascular Reconstruction Device to Salvage Acute Ischemic Occlusions Refractory to Traditional Endovascular Recanalization Methods.
    Date April 2010
    Journal Journal of Neurosurgery
    Excerpt

    Acute revascularization has been associated with improved stroke outcomes. The Prolyse in Acute Cerebral Thromboembolism (PROACT II) trial achieved recanalization rates of 66%. The Multi Mechanical Embolus Removal in Cerebral Ischemia (Multi MERCI) trial achieved recanalization in 70% of patients. However, these interventional tools are not always successful. The Enterprise vascular reconstruction device was recently introduced for treatment of cerebral aneurysms previously untreatable with endovascular techniques. The authors evaluated a multicenter experience using this stent as a salvage revascularization tool for acute stroke treatment.

    Title Temporary Endovascular Bypass: a Novel Treatment for Acute Stroke.
    Date November 2009
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    Intracranial stent placement is emerging as an effective treatment for acute stroke. As a means to avoid stent-associated complications and capitalize on stent-placement-related advantages, the concept of a "temporary endovascular bypass" (TEB) for stroke therapy was recently reported. In this technique, a stent is temporarily deployed for instant recanalization. Once sufficient flow is established to maintain vessel patency, the stent is recaptured and withdrawn. We report a second case to further characterize the merits of TEB.

    Title First Food and Drug Administration-approved Prospective Trial of Primary Intracranial Stenting for Acute Stroke: Saris (stent-assisted Recanalization in Acute Ischemic Stroke).
    Date November 2009
    Journal Stroke; a Journal of Cerebral Circulation
    Excerpt

    Acute revascularization is associated with improved outcomes in ischemic stroke patients. However, it is unclear which method of intraarterial intervention, if any, is ideal. Numerous case series and cardiac literature parallels suggest that acute stenting may yield high revascularization levels with low associated morbidity. We therefore conducted a Food and Drug Administration-approved prospective pilot trial to evaluate the safety of intracranial stenting for acute ischemic stroke.

    Title Preoperative Embolization of Cerebral Arteriovenous Malformations with Onyx.
    Date May 2009
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    Preoperative embolization facilitates the surgical management of complex cerebral arteriovenous malformations (cAVMs). This analysis aims to investigate the risks for preoperative cAVM embolization with Onyx.

    Title Symptomatic Brainstem Cavernomas.
    Date March 2009
    Journal Neurosurgery
    Excerpt

    The goal of this study was to analyze the natural history of symptomatic brainstem cavernomas (medulla, pons, or midbrain) and outcome after surgical resection.

    Title Clipping of Very Large or Giant Unruptured Intracranial Aneurysms in the Anterior Circulation: an Outcome Study.
    Date January 2009
    Journal Journal of Neurosurgery
    Excerpt

    Patients with very large or giant unruptured intracranial aneurysms present with ischemic stroke and progressive disability. The aneurysm rupture risk in these patients is extreme-up to 50% in 5 years. In this study the authors investigated the outcome of surgical treatment for these very large aneurysms in the anterior circulation. METHODS Clinical data on 62 patients who underwent surgery for unruptured aneurysms (20-60 mm) between 1998 and 2006 were reviewed.

    Title Intradural Microanatomy of the Nerve Roots S1-s5 at Their Origin from the Conus Medullaris.
    Date September 2008
    Journal Journal of Neurosurgery. Spine
    Excerpt

    OBJECT: The conus medullaris and the nerve roots from S-1 to S-5 regulate bladder function as well as movement and sensation of the lower extremities. This most caudal region of the spinal cord has not been studied in great detail anatomically despite its important regulatory role. The goal of this analysis is to characterize the normal intradural microanatomy of the sacral nerve roots at their origin from the conus medullaris. METHODS: The thecal sacs from 20 cadavers were fixated in formaldehyde and dissected under the operative microscope. RESULTS: More than 50 rootlets originated from the conus medullaris over a distance of < 3 cm. The rootlets were loosely organized into bundles by the arachnoid membrane with decreasing diameters. These diameters were 1.7 mm (ventral)/2.4 mm (dorsal) at S-1, and 0.17 mm (ventral)/0.4 mm (dorsal) at S-5. The roots were separated by neither the dentate ligament nor interradicular gaps. The number of rootlets decreased in the rostrocaudal direction with 2 ventral and 5 dorsal rootlets at S-1, but only 1 ventral (inconsistently found) and 2 dorsal rootlets at S-5. Typically, 1 nerve anastomosis was present between adjacent dorsal roots from S-1 to S-4. Nerve anastomoses between ventral roots or rootlets of the same root were less frequent. The dorsal segment of origin (linea radicularis) decreased in length from 7.2 mm at S-1 to 4.8 mm at S-5. CONCLUSIONS: The current study provides anatomical details and specific morphometric data of the intradural contents at the level of the conus medullaris. This information is valuable for intraoperative orientation, endoscopic navigation, and possible intradural nerve stimulation.

    Title Endothelina Receptor Antagonist Bsf-208075 Causes Immune Modulation and Neuroprotection After Stroke in Gerbils.
    Date September 2007
    Journal Brain Research
    Excerpt

    Leukocytes contribute to the ischemia-reperfusion injury. Recent studies suggested endothelins could be important mediators for leukocyte activation in stroke. We tested if the endothelinA receptor antagonist BSF-208075 (ambrisentan) could reduce an ischemic lesion by modulation of leukocyte-endothelium interactions. Twenty-four gerbils underwent either a sham operation (n=6) or 15 min of bilateral carotid artery occlusion resulting in global cerebral ischemia. Ischemic animals received normal saline (n=6), 5 mg/kg BSF-208075 (n=6) or 30 mg/kg (n=6) administered intravenously at 10 min of reperfusion. Leukocytes rolling or adhering to endothelium were counted by intravital microscopy in parietal subsurface venules through a closed cranial window. BSF-208075 dose-dependently reduced postischemic leukocytes rolling (7.3+/-2.3 vs. 3.3+/-1.4 vs. 0.7+/-0.7 [n/100 microm/min]; p<0.05) and adhering (5.3+/-1.4 vs. 2.7+/-1.6 vs. 1.3+/-0.5 [n/100 microm/min]; p<0.05). Cerebral blood flow was not significantly changed by BSF-208075. Cortical neurons [n/mm2] in an area corresponding to the in vivo microscopy were dose-dependently preserved 7 days after ischemia (2456+/-687 vs. 3254+/-245 vs. 3780+/-168; p<0.05). Conclusion: Endothelins mediate leukocyte activation in ischemic stroke. The endothelinA receptor antagonist BSF-208075 administered during reperfusion reduces the postischemic leukocyte activation and causes neuroprotection.

    Title Spontaneous Spinal Epidural Arteriovenous Fistulae in Neurofibromatosis Type-1.
    Date September 2006
    Journal Surgical Neurology
    Excerpt

    BACKGROUND: NF-1 is one of the most common autosomal-dominantly inherited genetic disorders with an incidence of approximately 1:3500. We report a case and review the literature to characterize spontaneous spinal AVF that occur in neurofibromatosis (NF-1). CASE REPORT: A 51-year-old woman presented with NF-1 and progressive radiculomyelopathy. Angiography revealed an AVF terminating in a giant intraspinal epidural varix extending paraspinally through the C3/4 neural foramen. Trapping of the AVF attempted 18 years earlier prevented endovascular access for embolization, and vigorous bleeding made direct surgical resection impossible. Therefore, as palliation, arterial feeding collaterals were occluded, and surgically exposed tortuous veins were packed with coils. Laminectomies and partial resection of the epidural varix resulted in subtotal occlusion with clinical improvement. CONCLUSION: The spinal AVF associated with NF-1 appears to show dominant venous drainage to the intraspinal extradural and paraspinal venous plexus without evidence of intradural drainage. The vertebral artery is typically the origin of the fistula. A giant venous varix and numerous collateral feeders to the vertebral artery may give an AVM-like appearance. Clinically, the fistulae produce a syndromic triad including symptoms of NF-1, progressive radiculomyelopathy, and a bruit. Treatment is direct attack on the fistula by either surgery or embolization. If, however, a direct approach cannot be chosen, occlusion of feeding vessels combined with laminectomies can result in long-term symptomatic improvement.

    Title Surgical Resection of Locally Advanced Granular Cell Tumor of the Orbit.
    Date August 2006
    Journal The Journal of Craniofacial Surgery
    Excerpt

    We report a case of locally advanced granular cell tumor of the orbit treated by a multidisciplinary surgical approach. A 49-year-old woman with a recently biopsied granular cell tumor of the orbit was referred to our tertiary care cancer center for evaluation of a right-sided globe ptosis and a palpable mass in the right orbit that had been present for approximately two years. Magnetic resonance imaging showed a large orbital mass that extended posteriorly to the orbital apex and anteriorly to the levator and superior rectus muscle complex. A workup including computed tomography of the chest, abdomen, and pelvis did not show any metastatic foci. Surgical resection of the mass was undertaken via a frontozygomatic craniotomy supplemented by an anterior orbitotomy to repair the levator aponeurosis and the superior oblique tendon, which were partially resected with the mass. Histologic evaluation of the mass revealed solid nests of polygonal cells that had centrally located, round nuclei with abundant eosinophilic granular cytoplasm. The cytoplasmic granules were positive on the periodic acid-Schiff reaction and were diastase-resistant. Immunohistochemical staining was positive for S-100 protein. During the most recent follow-up visit six months after surgery, the patient had no clinical evidence of tumor recurrence, had minimal residual ptosis and exposure keratopathy, and had stable visual function.

    Title Capillary Flow and Diameter Changes During Reperfusion After Global Cerebral Ischemia Studied by Intravital Video Microscopy.
    Date April 2004
    Journal Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism
    Excerpt

    The reaction of cerebral capillaries to ischemia is unclear. Based on Hossmann's observation of postischemic "delayed hypoperfusion," we hypothesized that capillary flow is decreased during reperfusion because of increased precapillary flow resistance. To test this hypothesis, we measured cerebral capillary erythrocyte velocity and diameter changes by intravital microscopy in gerbils. A cranial window was prepared over the frontoparietal cortex in 26 gerbils anesthetized with halothane. The animals underwent either a sham operation or fifteen minutes of bilateral carotid artery occlusion causing global cerebral ischemia. Capillary flow velocities were measured by frame-to-frame tracking of fluorescein isothiocyanate labeled erythrocytes in 1800 capillaries after 1-hour reperfusion. Capillary flow velocities were decreased compared to control (0.25 +/- 0.27 mm/s vs. 0.76 +/- 0.45 mm/s; P<0.001). Precapillary arteriole diameters in reperfused animals were reduced to 76.3 +/- 6.9% compared to baseline (P<0.05). Capillary diameters in reperfused animals (2.87 +/- 0.97 microm) were reduced (P<0.001) compared to control (4.08 +/- 1.19 microm). Similar reductions of precapillary (24%) and capillary vessel diameters (30%) and absolute capillary flow heterogeneity indicate that delayed (capillary) hypoperfusion occurs as a consequence of increased precapillary arteriole tone during reperfusion.

    Title Stent/coil Treatment of Very Large and Giant Unruptured Ophthalmic and Cavernous Aneurysms.
    Date
    Journal Surgical Neurology
    Excerpt

    BACKGROUND: Treatment of VLGUIA remains a challenge. To reduce mass effect and achieve complete occlusion, open surgery has been our favored treatment. However, endovascular therapy is preferred for lesions in the cavernous sinus or for older patients with complicating medical problems. The goal of this study is to investigate outcome of stent and/or coil treatment of VLGUIA. METHODS: Beginning in 2002, the neuroform stent has been available to the University of Texas Southwestern Medical Center in Dallas. Since then until 2006, 15 patients were treated for VLGUIA with stenting and/or coiling at this institution. These 15 patients were used for a retrospective analysis in this study. RESULTS: Median patient age was 65 years, median aneurysm size was 27 mm (20-37 mm), and median follow-up time was 22 months. Eight aneurysms were localized in the cavernous sinus and 7 at the ophthalmic segment of the internal carotid artery. Four aneurysms were completely occluded (100%); 3 aneurysms, nearly complete (90%-99%); and 8 aneurysms, partial (<90% occlusion). Twelve patients required retreatment. Final GOS was 1 (good recovery) in 11 patients, 2 (moderate disability) in 3 patients, and 3 (severely disabled) in 1 patient. No patient died or deteriorated. CONCLUSIONS: Stent/coil management of VLGUIA is constantly evolving. Current treatment results are promising, with very low morbidity/mortality. Disadvantage is the frequent persistence of residual aneurysm.

    Title A1-a2 Interposition Grafting for Surgical Treatment of a Giant "unclippable" A1 Segment Aneurysm.
    Date
    Journal Surgical Neurology
    Excerpt

    BACKGROUND: Although various bypass options for the surgical treatment of middle cerebral artery aneurysms have been described, little has been reported about similar options for complex aneurysms of the anterior cerebral artery. CASE DESCRIPTION: We report the case of a 15-year-old adolescent girl, in whom a giant A1 segment aneurysm was successfully treated with aneurysm resection followed by saphenous vein interposition grafting. CONCLUSION: Recognizing the option for a bypass can be the key to success in the surgical management of complex intracranial aneurysms. A potential donor vessel of appropriate size (either arterial or venous) should be prospectively identified. Interposition grafting is technically feasible for proximal anterior cerebral artery aneurysms, although technically demanding.

    Title Cerebral Phaeohyphomycosis Mimics High-grade Astrocytoma.
    Date
    Journal Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
    Excerpt

    The incidence of cerebral phaeohyphomycosis, an infection caused by a dark-pigmented fungus, is increasing. The infection may mimic a high-grade glioma clinically and radiographically. Magnetic resonance spectroscopy may be helpful in differentiating the two. We report two cases to increase the awareness of cerebral phaeohyphomycosis in the clinical neurosciences. Early biopsy establishing the diagnosis, followed by aggressive combined surgical and medical management is necessary for a good outcome.

    Title Intraventricular Ganglioglioma.
    Date
    Journal Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
    Excerpt

    Gangliogliomas are mixed tumors consisting of both glial elements and differentiated neurons. Although any part of the central nervous system can be affected, little is known about intraventricular gangliogliomas. A patient with a ganglioglioma is presented in the previously unreported location of the anterior third ventricle at the foramen of Monro, mimicking a colloid cyst. We review all other reported cases of intraventricular ganglioglioma (n=6) to characterize this entity. Intraventricular gangliogliomas typically affect younger patients with female predominance (male:female, 2:5; median age 25 years). Symptoms occur secondary to obstruction of physiological cerebrospinal fluid circulation. Complete surgical resection with re-establishment of cerebrospinal fluid drainage is the goal of treatment.

    Title Endovascular Management of Symptomatic Spasm of Radial Artery Bypass Graft: Technical Case Report.
    Date
    Journal Neurosurgery
    Excerpt

    To describe the technique of endovascular access for treatment of vasospasm of a radial artery bypass graft from the occipital artery to the M3 branch of the middle cerebral artery (MCA) in a patient with moyamoya disease.

    Title Retrograde Trans-posterior Communicating Artery Snare-assisted Rescue of Lost Access to a Foreshortened Pipeline Embolization Device: Complication Management.
    Date
    Journal Neurosurgery
    Excerpt

    BACKGROUND AND IMPORTANCE: The Pipeline embolization device (PED; Covidien Vascular Therapies, Mansfield, Massachusetts) is a promising, yet experimental, vascular reconstruction device for the treatment of complex intracranial aneurysms. We present a PED-related complication and describe a salvage strategy. CLINICAL PRESENTATION: A 64-year-old woman underwent PED-assisted parent vessel reconstruction for her giant cavernous internal carotid artery (ICA) aneurysm. During placement of the first PED, the proximal part of the PED foreshortened and was displaced into the aneurysm sac. Multiple subsequent attempts to recatheterize the PED failed, and, ultimately, distal access through and beyond the PED was lost. Therefore, completion of the Pipeline construct by stacking PEDs for definitive treatment was prevented. Retrograde access of the PED was gained from the distal ICA through a microwire that was advanced from the basilar artery through the posterior communicating artery. The microwire from the distal ICA was grasped with a snare from the proximal ICA and pulled down to the cervical ICA. The opened snare around the microwire was used as a lasso to advance a microcatheter from the cervical ICA through the PED to regain distal access. Five more PEDs were used to achieve complete parent vessel reconstruction and aneurysm obliteration. CONCLUSION: Maintaining distal access is critical until the entire parent vessel is reconstructed, especially when multiple PEDs are required. The salvage technique described may help regain distal access if it is lost during the procedure.

    Title Use of the Outreach Distal Access Catheter for Microcatheter Stabilization During Intracranial Arteriovenous Malformation Embolization.
    Date
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    SUMMARY: The Outreach DAC is an intermediate-sized catheter designed for use with the Merci clot retriever in acute stroke. We investigated its utility as an adjunctive device during AVM pedicle embolization. In the authors' opinion, the DAC provided additional guide-catheter and microcatheter support, improved selective angiographic visualization of AVM angioarchitecture, aided microcatheter removal from its embedded position in the AVM Onyx cast, and enhanced local microcatheter control and safety, compared with embolization with the guide and microcatheter alone.

    Title Delayed Endovascular Revascularization in a Patient with Progressive Neurological Deterioration from Bilateral Intracranial Vertebral Artery Occlusions: Case Report.
    Date
    Journal Neurosurgery
    Excerpt

    This article describes delayed endovascular revascularization in a patient with clinical and radiographic evidence of posterior circulation hemodynamic failure in the setting of intracranial occlusive lesions.

    Title Endovascular Treatment of Patients with Intracranial Stenosis with Moyamoya-type Collaterals.
    Date
    Journal Journal of Neurointerventional Surgery
    Excerpt

    Purpose The authors report the endovascular treatment of intracranial stenosis in six patients with moyamoya-type collaterals. Patients All patients previously had experienced a stroke or transient ischemic attack. Lesion locations included a unilateral M1-segment lesion in five patients; and ipsilateral internal carotid artery (ICA)-T, M1 and A1 lesions with contralateral supraclinoid ICA stenosis in one patient. Mean M1 stenosis was 77.3±14.3%. Results Six patients had balloon angioplasty; in one, a Wingspan stent deployed successfully after angioplasty failed to relieve the stenosis. Mean post-treatment stenosis was 41.0±33.0%. In one patient, vessel rupture occurring during angioplasty caused severe disability. Two patients were asymptomatic for 4 years and 6 months, respectively. One asymptomatic patient had severe restenosis re-treated with intracranial stenting. Two patients became symptomatic and had re-treatment at 1 and 2 months, respectively. Conclusion Endovascular treatment of intracranial stenosis with moyamoya-type collaterals is possible but is associated with high rates of symptomatic restenosis and target-lesion revascularization.

    Title Use of the Outreach Distal Access Catheter As an Intracranial Platform Facilitates Coil Embolization of Select Intracranial Aneurysms: Technical Note.
    Date
    Journal Journal of Neurointerventional Surgery
    Excerpt

    The Outreach distal access catheter (DAC; Concentric Medical, Mountain View, California, USA) has been designed to assist the Merci device (Concentric Medical) with clot retrieval in the setting of acute stroke. Its application for coil embolization of intracranial aneurysms was investigated.


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