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Abstract BACKGROUND There is a paucity of literature regarding treatment options for extracranial pseudoaneurysms of the internal carotid artery (ICA). To date, Pipeline Embolization Device (PED; Medtronic Inc) use for the treatment of extracranial pseudoaneurysms of the ICA has only been reported from single-center case series. OBJECTIVE To evaluate the safety and efficacy of PED for the treatment of extracranial ICA pseudoaneurysms. METHODS This is a multicenter retrospective study involving 6 high-volume tertiary academic institutions in the United States. We analyzed patients with extracranial ICA pseudoaneurysms treated with PED between January 1, 2011, and January 1, 2019. Clinical assessment was performed pre- and postintervention using the modified Rankin Scale (mRS) and National Institution of Health Stroke Scale (NIHSS) at a minimum of 4-mo follow-up. RESULTS A total of 28 pseudoaneurysms with a mean diameter of 17.7 mm (range: 4.1-52.5 mm) were treated with PED in 24 patients at 6 participating centers. The mean age was 52.1 yr (17-73) ± 14.3 with 14 females and 10 males. At a mean of 21-mo (range 4-66 mo) follow-up, complete occlusion was achieved in 89% (n = 25/28), with near-complete occlusion (>90% occlusion) in the remainder. There were no periprocedural complications. Postprocedure NIHSS was 0 in 88% (n = 21/24) and 1 in 12% (n = 3/24) of patients, and mRS was 0 in 83% (n = 20/24) and 1 in 17% (n = 4/24) of patients. CONCLUSION The treatment of extracranial ICA pseudoaneurysms with PED is safe and effective in selected patients. Randomized controlled trials and prospective cohort studies are needed to establish the role of flow diversion for ICA pseudoaneurysms. Graphical Abstract Graphical Abstract

Introduction/PurposeMiddle meningeal artery embolization (MMAe) can be performed as either a standalone treatment (Upfront) or in adjunct to surgical evacuation (Prophylactic within 2 weeks of surgical intervention or Salvage when >2 weeks of surgical intervention) to reduce nonacute subdural hematoma (NASDH) recurrence. Data from the EMBOLISE trial have established the efficacy of particle and liquid embolics in MMAe. These embolics confer the risk of non-target embolization ranging from vasa nervosum damage with cranial nerve palsy to ischemic stroke via external to internal carotid anastomoses.In 2023, Iyer-et-al evaluated the efficacy of long-coil-construct to spinosum MMAe in a 45 patient-cohort with 34 minutes mean fluoroscopy time. Our study further evaluates the efficacy of primary coil MMAe with shorter length coil-constructs. Null hypotheses include reduced fluoroscopy times, low failure rate, and collection size with density reduction over a 1–3 month period.Materials and MethodsRetrospective review of primary coil MMAe cases categorized as Upfront, Prophylactic, or Salvage was performed. Fluoroscopy time, MMA size via Spinosum Roentgen Index (S.R.I.), MMA angiographic diameter, coils utilized, pre-and-post MMAe head CT scans with collection size and Hounsfield unit density measurements, and patient outcomes were recorded.Results65 primary coil MMAe procedures (53 males, 18 females; mean 71 years, minimum 9 years, maximum 96 years) for NASDH management were identified. 29 unilateral MMAe and 36 bilateral MMAe were performed January 2022 to January 2025. 34 Upfront, 31 Prophylactic, and 6 Salvage MMAe procedures were performed with low fluoroscopy times (mean 5.8 minutes, minimum 1.6 minutes, maximum 15.8 minutes). Correlation of S.R.I. with MMA size (P<0.001) aided in 1–3 mm diameter coil selections. 63/65 cases resulted in statistically-significant reductions in NASDH size (p<0.05) and non-statistically significant reductions in NASDH density (p>0.05) despite MMAe subtype (figure 1A and 1B). One case requiring embolization of an accessory MMA given native MMA absence yielded similar-to-cohort reduction in NASDH size without cranial neuropathy. Two failures were attributed to incomplete MMA occlusion from initial coil pack (figure 1B right upper quadrant), one of whom returned for re-embolization.ConclusionCoil embolization is an effective well-tolerated treatment for NASDH resulting in significant reductions in collection size and trended decrease in density reduction over time, noting scar/dural thickening may yield higher density measurements. Pre-intervention imaging aides in sizing coil constructs while reducing radiation exposure. Short-coil-constructs straddling the frontoparietal and temporal divisions (Y configuration) or individually in divisions can be placed without worry of ECA-ICA anastomoses.Abstract E-147 Figure 1DisclosuresM. Afridi: None. A. Abramyan: None. A. Soliman: None. E. Nourollah-Zadeh: None. H. Sun: None. G. Gupta: None. S. Roychowdhury: None. S. Sundararajan: None.

There is no neoadjuvant immunotherapy for early-stage oral cancer patients. We report a single-arm, open-label, pilot clinical trial assessing the efficacy and safety of topical toll-like receptor-7 (TLR-7) agonist, imiquimod, utilized in a neoadjuvant setting in early-stage oral squamous cell carcinoma (OSCC). The primary endpoint is reduction in tumor cell counts assessed by quantitative multiplex immunofluorescence and the immune-related pathologic response. The secondary endpoint is safety. 60% of patients experienced a 50% reduction or greater in tumor cell count post-treatment (95% CI = 32% to 84%). Similarly, 60% of patients had immune-related major pathologic response (irMPR) with two complete pathologic responses, and 40% had partial response (PR) with the percent residual viable tumor ranging from 25% to 65%. An increase in functional helper and cytotoxic T-cells significantly contributed to a reduction in tumor (R=0.54 and 0.55, respectively). The treatment was well tolerated with the application site mucositis being the most common adverse event (grades 1-3), and no grade 4 life-threatening event. The median follow-up time was 17 months (95% CI = 16 months - not reached), and one-year recurrence-free survival was 93% of evaluable patients. Neoadjuvant imiquimod immunotherapy could be safe and promising regimen for early-stage oral cancer. ClinicalTrials.gov, Identifier NCT04883645.