{
  "abstract": "Background NeoCast™ (Arsenal Medical, Inc. Waltham, MA) is a next-generation, solvent-free, and non-adhesive embolic material designed specifically for procedures where deep distal penetration is desired. We established the new Geometric Hierarchical Opacification Scoring of Middle Meningeal Artery (MMA) Embolization Therapy (GHOST) system, which allows summarization of the distribution of embolic material at a group level to describe embolization patterns.Methods Secondary analyses of the 30 embolized hematoma (24 patients, 6 bilaterally treated) in the EMBO-02 Study for chronic subdural hematoma (cSDH; ACTRN12624000659505, NeoCast) were conducted by a core laboratory (Eppdata, Hamburg, Germany) using independent double reading. The GHOST score (see figure 1) was used to analyze the distribution of embolic material in 18 different locations projected onto the final unsubtracted angiographic images. Adachi classification was used to identify the preexisting MMA anatomy for each hematoma.Results NeoCast was observed in distal branches in all embolized hematoma (26 with combined proximal cast, 4 without). The most frequently reached locations were U2c and U3c (see figure 1) in ≥80% of the hematomas. The total number of fields showing NeoCast on GHOST scoring in individual hematoma ranged from 4 (22%) to 16 (89%). At least one of the most distal GHOST locations (U3a to U3d) was embolized in all hematoma: one field (5, 17%), two fields (11, 36%), three fields (9, 30%), and all four fields (5, 17%). The more proximal arch (U2a to U2d) was embolized in one field (2, 7%), two fields (7, 23%), three fields (11, 36%), all four fields (9, 30%), or not embolized (1, 3%). There was a tendency toward more complete NeoCast filling in the posterior sections (U2a, U2b, U3a, U3b) in patients with Adachi Type C anatomy (distal origin at the orbital apex or beyond), but no significant association with preexisting anatomy was found.Discussion Distal penetration was achieved in all patients after MMAE using NeoCast, reaching the most distal GHOST locations in 100% of patients. The embolization pattern was highly consistent, with two of the most distal locations included in at least 80% of patients. This pattern was achieved independently of preexisting MMA anatomy (Adachi classification). Further analysis is warranted to understand the potential clinical impact and utilization of the GHOST scale.Disclosures J. Fiehler: 1; C; Arsenal Medical. 4; C; EppData. L. Slater: 1; C; Arsenal Medical. T. Phillips: 1; C; Arsenal Medical. L. de Villiers: 1; C; Arsenal Medical. H. Kneip: 5; C; EppData. M. Bechstein: None. D. Fiorella: 2; C; Arsenal Medical. 4; C; Arsenal Medical. J. Groom: 4; C; Arsenal Medical. 5; C; Arsenal Medical.Abstract E-324 Figure 1(A) GHOST score with labels for 18 different regions (B) Percentage of patients where NeoCast was observed in the individual regions",
  "authors": [
    {
      "affiliations": [
        "Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"
      ],
      "name": "J Fiehler"
    },
    {
      "affiliations": [
        "Monash university, Aspendale, Australia"
      ],
      "name": "L Slater"
    },
    {
      "affiliations": [
        "Sir Charles Gairdner Hospital, Perth, AUSTRALIA"
      ],
      "name": "T Phillips"
    },
    {
      "affiliations": [
        "Gold Coast University Hospital, Southport, Australia"
      ],
      "name": "L de Villiers"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Hamburg, Germany"
      ],
      "name": "H Kneip"
    },
    {
      "affiliations": [
        "University Medical Center Hamburg-Eppendorf, Hamburg, Germany"
      ],
      "name": "M Bechstein"
    },
    {
      "affiliations": [
        "SUNY SB, Stony Brook, NY"
      ],
      "name": "D Fiorella"
    },
    {
      "affiliations": [
        "Arsenal Medical, Waltham, MA"
      ],
      "name": "J Groom"
    }
  ],
  "title": "E-324 Consistent distal distribution of neocast described by the novel GHOST scoring system",
  "uid": "6d552124-638a-54ce-917b-6bc784cca43c"
}