*Article* **Study on the Trade-Off Synergy Relationship of "Production-Living-Ecological" Functions in Chinese Counties: A Case Study of Chongqing Municipality**

**Ling Cheng 1,2 , Haiyang Cui 1,\*, Tian Liang 3 , Dan Huang 3 , Yuanxia Su 3 , Zhiyong Zhang 4,5,\* and Chuanhao Wen 6**

**Abstract:** The trade-off and coordinated development of the "production-living-ecological" functions (PLEFs) of an area is an important basis for the optimization of the spatial pattern of the land, and helps to promote the harmonious symbiotic relationship between human beings and nature. This paper combines ecological niche theory, a coupling coordination model, and a trade-off synergy model to construct an evaluation index system for Chinese county PLEFs. Quantitative methods were used to measure spatiotemporal evolution characteristics, trade-off synergy of PLEFs in 38 counties in Chongqing, China, and the coupling coordination degree between PLEFs. The results showed that the ecological niche width of the "production-ecological" function revealed an overall growth trend. However, there was a mismatch in regional development of the "production-ecological" function, showing dislocation characteristics of "high in the west and low in the east" and "high in the east and low in the west." The niche width of the life function is similar to the comprehensive niche width of PLEFs, showing the characteristics of fluctuation and partition change. PLEFs and both the aforementioned functions showed distribution characteristics of "high in the west and low in the east," with the whole moving towards the stage of coordinated coupling, of which the "production-living" function has the highest coupling level. The functional coupling coordination degree of "production-living-ecological" is generally manifested as "high in the west and low in the east," and changing from the primary stage of imbalance to well-coordinated development. The "production-ecological" and "living-ecological" functions are in low-level imbalance in the primary and moderate coordination stages. Additionally, the evolution trend of the "production-ecological" and the "living-ecological" functions are similar, showing alternating and fluctuating development characteristics. Overall, in the past 20 years, Chongqing's "living-production" function has changed from a trade-off model to a collaborative development relationship, and the "living-ecological" function is generally based on a collaborative development relationship. The "ecological function" is manifested as a trade-off constraint relationship. Moreover, the coordinated development level of "living-production," "living-ecological," and "production-ecological" functions in the central urban area has been greatly improved, while counties have gradually shown different degrees of trade-offs.

**Keywords:** PLEFs; spatiotemporal evolution; ecological niche theory; coupling coordination; Chongqing City


*3.3.4 Comparison of optimism, partial statements and overall factor in sports-active, sports-inactive boys, sports-active girls and sports-inactive girls*

The highest value of the score reached statement O4 about the belief that things will work out, no matter how difficult they seem (4.28) in sports-active boys and the lowest score was in the statement O1 about the optimism of the future (2.69) in sports-inactive girls (**Figure 12**).

 No statistical significance in differences was found between sports-inactive boys and sports-active girls.

 Social connectedness is very important in adolescents´ development. Strong friendships that develop during adolescence last for years.

### *3.4.1 Comparison of connectedness in boys and girls*

Comparing the statements and the overall connectedness factor, we found that all statements (C1, C2, C3, C4) and the overall connectedness factor have a greater value of scores in girls. Three statements show statistical significance in comparison with boys: C1 (U = 4782, p = .020), C3 (U = 4780, p = .015), C4 (U = 4634.5, p = .010) (**Figure 13**).

The girls presented more satisfying relationships with others than boys.

### *3.4.2 Comparison of connectedness in sports-active boys and sports-inactive boys*

Sports-active boys are those who expressed that they have someone with whom they can share the good news, have people who stand by and care about them. The persuasion was so strong that their opinion on this issue brought statistical significance in statements C1 (U = 823, p = .002), C2 (U = 938, p = .015), C3 (U = 984.5,

*Well-Being and Happiness Feelings in Sports-Active and Sports-Inactive Adolescents DOI: http://dx.doi.org/10.5772/intechopen.108957*

### **Figure 12.**

*Optimism: Partial statements and overall factor in sports-active boys, sports-inactive boys, sports-active girls and sports-inactive girls.*

p = .037) and the overall connectedness factor C (U = 883, p = .007) in comparison with sports-inactive boys (**Figure 14**).

### *3.4.3 Comparison of connectedness in sports-active girls and sports-inactive girls*

The girls, nevertheless, whether sports-active or sports-inactive, are almost about at the same level of expression about friendships, about having someone to solve problems with or having real friends. Surprisingly, sports-inactive girls in all statements, except statement C1, reached higher values of scores. It was for three statements (C2, C3 and C4) and the overall connectedness factor. Only one statement C3 shows statistical significance (U = 1275.5, p = .021) (**Figure 15**).


4. Feature-based advanced hybrid manufacturing process planning system (FAH-PS)

The Feature-based Advanced Hybrid Manufacturing Process Planning System (FAH-PS) presented by [19] may be applied to multiple types of hybrid manufacturing processes such as casting-, injection molding-, and additivesubtractive. FAH-PS utilizes a modular and extensible software framework, which was intended to address: (1) the determination of operations final order in a process plan, (2) the types of processes supported in a hybrid process plan for holes, flats and slot features, and (3) the general extensibility of process planning systems for future program advancements [19]. The decision structure of FAH-PS uses feature specific geometric, tolerance, and material data inputs to generate automated

process plans based on a user-specified critical feature precedence [19]. Individual modules are used to process machine information about specific feature types (hole, pocket, slot, etc.) and calculate required tooling and approximate machining times for each feature and part [19]. Based on user preference, FAH-PS can also generate additional process plans that aim to minimize tool changes, orientation changes, etc. to improve process times [19]. Figure 10 shows the decision tree that FAH-PS follows in the development of process plans.

This planning system is one example of the demonstrated feasibility of automated and semi-automated process planning for hybrid manufacturing systems of small batch parts. It was shown in [19] to be a valuable tool during the design and preparation stages of production as it reduced difficulties in obtaining optimal machining strategies quickly with improved levels of accuracy. Incorporation of other features and types of processes as well as detailed assessment of costs for the auto-generated process plans are still needed, however this planning system is a

Advanced Manufacturing Using Linked Processes: Hybrid Manufacturing

Within this chapter several hybrid manufacturing processes were outlined and an overview of factors affecting the development of process plans for these processes was given. The complexities of process planning for multi-staged processes and optimization of such process plans was also explored. Effective planning for HMPs requires a shift from manual approach to an automated process planning system. The FAH-PS system was provided as one example of a system designed to

, Carter Keough1

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

, Richard Wysk1

good guide for future developmental efforts.

DOI: http://dx.doi.org/10.5772/intechopen.88560

5. Conclusion

plan for such HMP.

Author details

Katie Basinger2

129

and Ola Harrysson1

3 Stryker, NJ, United States

\*, Caroline Webster3

1 North Carolina State University, Raleigh, NC, United States

2 The University of Florida, Gainesville, FL, United States

\*Address all correspondence to<EMAIL_ADDRESS>
provided the original work is properly cited.

A case study was completed using the FAH-PS framework of a HMP bone plate shown below in Figure 11. More information regarding the specifics of this study can be found in [19]. In summary, FAH-PS produced 4 automated process plans, the results shown in Table 1.

Figure 10. FAH-PS decision structure (adapted from [19]).

Figure 11.

Case study of using FAH-PS for finishing of a patient-specific bone plate (reproduced with permission from [16]).

#### Table 1.

FAH-PS case study results (recreated results from [19]).

Advanced Manufacturing Using Linked Processes: Hybrid Manufacturing DOI: http://dx.doi.org/10.5772/intechopen.88560

This planning system is one example of the demonstrated feasibility of automated and semi-automated process planning for hybrid manufacturing systems of small batch parts. It was shown in [19] to be a valuable tool during the design and preparation stages of production as it reduced difficulties in obtaining optimal machining strategies quickly with improved levels of accuracy. Incorporation of other features and types of processes as well as detailed assessment of costs for the auto-generated process plans are still needed, however this planning system is a good guide for future developmental efforts.


*Edited by Belma Işık Aslan and Fatma Deniz Uzuner*

This book provides information on the current technological developments and new concepts in orthodontic treatment procedures. The main concepts of the book are scope innovations in accelerated tooth movement, new developments such as corticotomy, microperforations (MOP), piezosicion, photobiostimulation, laser in orthodontics, chemical agents, as well as complications and risks. The book contains interdisciplinary managements involving surgery first, cleft lip and palate therapy, orthognathic surgery, and obstructive sleep apnea. This internationally-recognized specialty is continuing to experience advancements in technology, instrumentation, and treatment methods.

ISBN 978-1-78985-181-6

Current Approaches in Orthodontics

Published in London, UK © 2019 IntechOpen © edwardolive / iStock

IntechOpen Book Series Dentistry, Volume 2


**5. Alternative microcatheterization of target vessel via a collateral route**

The circle of Willis provides a natural conduit to access contralateral or carotid to basilar (or vice-versa) circulations. In the vast majority of cases, adequate access may be obtained through direct ipsilateral routes; however, due either to proximal vessel occlusion or distal vessel entry angles, these alternate routes through the circle of Willis provide easier microcatheter entry angles.

Similar patterns of distal arterial collateralization can often be expected in PICA, AICA and SCA circulations. In cases of PICA ruptured dissections or dissecting aneurysms, proximal PICA can be occluded without needs of microsurgical bypass anastomosis. (Figure 21).

Fig. 12. A 38-year-old man with a left PCA territory embolic infarct was found to have a traumatic giant left VA dissecting aneurysm and DAVF from a fall 2 years prior to

**5. Alternative microcatheterization of target vessel via a collateral route**

The circle of Willis provides a natural conduit to access contralateral or carotid to basilar (or vice-versa) circulations. In the vast majority of cases, adequate access may be obtained through direct ipsilateral routes; however, due either to proximal vessel occlusion or distal vessel entry angles, these alternate routes through the circle of Willis provide easier

giant aneurysm.

microcatheter entry angles.

treatment. (A and B) Three-dimensional and two-dimensional angiograms show a giant left VA dissecting aneurysm and a DAVF. (C) The right VA angiogram demonstrates competent flow in the right VA. (D and E) Due to extremely high flow in the giant aneurysm, the DAVF was unable to be catheterized until occlusion of the left VA at the origin of the aneurysm. The left traumatic vertebral DAVF was catheterized from the right VA through the VB junction to the left VA. The *black arrow* indicates the fistula. *Open arrows* indicate the microcatheter route. (F) The fistula and residual filling of the giant aneurysm were treated successfully with coil occlusion through the contralateral VA to the left vertebral DAVF and

Fig. 13. A 48-year-old woman with a subarachnoid hemorrhage due to a left P2–P3 junction ruptured aneurysm. (A and B) Lateral view and anteroposterior (AP) view of original VA angiogram (*arrow in B*). (C and D) Left ICA AP and lateral angiography. (E and F) Left PCA P2 TBO. The left ICA angiogram, while the left P2 was occluded with a balloon, revealed left ACA to PCA cortical collateralization (*black arrow*) with retrograde opacification during the late arterial phase. In F, *open arrow* indicates the balloon; *arrowhead* indicates the retrograde partially opacified P2-P3 aneurysm. (G and H) Ultimately, this aneurysm was coil embolized completely with balloon-remodeling technique; and the distal PCA branches were preserved anterogradely.

A sharp reversely angulated origin of a vessel makes superselective ipsilateral catheterization difficult. For instance, access to the PICA or anterior inferior cerebellar artery (AICA) from the VA can be occasionally difficult, or in cases in which the carotid or bilateral VAs are occluded, the PCoA offers a distinct advantage. In these situations, if the caliber of the PCoA is adequate, effective catheterization of the desired vessel can be achieved (Figures 14 and 15). Naturally, a microcatheter can also go from one VA to the other through the VB junction (Figure 12, 16).7 Similarly, during treatment of broad-based aneurysms at the basilar or ICA terminus, ipsilateral placement of a stent may be inadequate for complete coverage of the aneurysm neck, necessitating a Y-configuration with increased risk of thromboembolic complications. In these cases, the following strategies offer distinct advantages: access from the contralateral carotid artery to pass a stent across the AcoA so

Intracranial Arterial Collateralization: Relevance in Neuro-Endovascular Procedures 193

Fig. 15. A 70-year-old woman presented with multiple events of VB insufficiency. Evaluation revealed bilateral VA occlusions. A) Injection of the left ICA (C) revealed the PCoA (B) as the principal supply to the BA (A) and the PCA (D). (B) A road-map angiogram reveals a guide catheter in the left ICA (B) with a microwire through the PCoA (C) and through the proximal BA (A) across an obvious stenosis into the distal VA. (C) After retrograde BA angioplasty, an ICA (A) angiogram reveals robust filling through the PCoA (B) into the basilar artery with markedly improved flow across the stenotic lesion into the BA junction (C), bilateral PICA, and VA (E, F). *With permission from Chiam PT, Mocco J, Samuelson RM, Siddiqui AH, Hopkins LN, Levy EI: Retrograde angioplasty for basilar artery stenosis: bypassing bilateral vertebral artery occlusions. J Neurosurg 110:427-430, 2009*

Fig. 16. A 65-year old man presented with neck-movement-related VB insufficiency. The left VA was noted to be occluded extracranially. (A) Right VA (A) angiogram revealed excellent flow into the BA with fenestration (B), a tight stenosis at the junction (C) of the left VA (D)

microballoon (A) was brought from the right VA (C) over a wire, which was placed into the left proximal VA (B). (C) Final angiogram revealing significant improvement (despite persistent stenosis) in distal left VA (A) flow noted into the proximal left VA (B) and left

with the BA, and a peak systolic angiographic jet opacifying the PICA (E). (B) A

PICA (C) following a right VA (D) injection. (E) Basilar artery.

Fig. 14. A 40-year-old man with a left intracranial VA dissection with a pseudoaneurysm just distal to the left PICA origin. (A and B) three-dimensional angiogram and lateral view of left VA two-dimensional angiogram. *Arrows* indicate the pseudoaneurysm at the dissection site. (C) Left ICA angiogram revealed robust PCoA connecting the left ICA system to the VB system. (D) Due to limited distal flow from the dissecting aneurysm to the normal PICA origin, complete occlusion of the left VA was not achieved by balloonremodeling coiling through left VA catheterization. Therefore, superselective catheterization through a left ICA-PCoA-BA-left VA route allowed us to successfully occlude the diseased segment of the VA. *Arrows* in E indicate the microcatheter route. By comparison with the angiogram in C, the 3-month follow-up angiogram with right VA (E) and left VA (F, lateral view) runs shows the left VA supplying the left PICA without evidence of recurrent aneurysm.

that it ultimately sits across the entire neck of the aneurysm in the ICA terminus (from the ipsilateral ACA to the MCA) or from the carotid artery across the PCoA so that it sits from the ipsilateral PCA to contralateral PCA (Figure 17). In cases in which there is occlusion of one or more vessels to the circle of Willis, the circle provides an optimal opportunity to access diseased segments of vessels that are proximally occluded. These routes can be used to treat a variety of conditions, such as aneurysms (Figure 18), AVMs, or AVFs. Similarly, in cases of acute occlusion, even if the proximal vessel cannot be adequately revascularized, reestablishing flow across the circle may alleviate acute cerebral ischemia (Figure 19). In other situations, the circle may allow passage of endovascular implements that, despite patency, cannot be brought up through ipsilateral routes (Figure 22 -24). This is particularly relevant to situations in which the ipsilateral vessel may have spasm after subarachnoid hemorrhage (Figure 20) or be congenitally hypoplastic.

Fig. 14. A 40-year-old man with a left intracranial VA dissection with a pseudoaneurysm just distal to the left PICA origin. (A and B) three-dimensional angiogram and lateral view of left VA two-dimensional angiogram. *Arrows* indicate the pseudoaneurysm at the dissection site. (C) Left ICA angiogram revealed robust PCoA connecting the left ICA system to the VB system. (D) Due to limited distal flow from the dissecting aneurysm to the

normal PICA origin, complete occlusion of the left VA was not achieved by balloon-

hemorrhage (Figure 20) or be congenitally hypoplastic.

aneurysm.

remodeling coiling through left VA catheterization. Therefore, superselective catheterization through a left ICA-PCoA-BA-left VA route allowed us to successfully occlude the diseased segment of the VA. *Arrows* in E indicate the microcatheter route. By comparison with the angiogram in C, the 3-month follow-up angiogram with right VA (E) and left VA (F, lateral view) runs shows the left VA supplying the left PICA without evidence of recurrent

that it ultimately sits across the entire neck of the aneurysm in the ICA terminus (from the ipsilateral ACA to the MCA) or from the carotid artery across the PCoA so that it sits from the ipsilateral PCA to contralateral PCA (Figure 17). In cases in which there is occlusion of one or more vessels to the circle of Willis, the circle provides an optimal opportunity to access diseased segments of vessels that are proximally occluded. These routes can be used to treat a variety of conditions, such as aneurysms (Figure 18), AVMs, or AVFs. Similarly, in cases of acute occlusion, even if the proximal vessel cannot be adequately revascularized, reestablishing flow across the circle may alleviate acute cerebral ischemia (Figure 19). In other situations, the circle may allow passage of endovascular implements that, despite patency, cannot be brought up through ipsilateral routes (Figure 22 -24). This is particularly relevant to situations in which the ipsilateral vessel may have spasm after subarachnoid

Fig. 15. A 70-year-old woman presented with multiple events of VB insufficiency. Evaluation revealed bilateral VA occlusions. A) Injection of the left ICA (C) revealed the PCoA (B) as the principal supply to the BA (A) and the PCA (D). (B) A road-map angiogram reveals a guide catheter in the left ICA (B) with a microwire through the PCoA (C) and through the proximal BA (A) across an obvious stenosis into the distal VA. (C) After retrograde BA angioplasty, an ICA (A) angiogram reveals robust filling through the PCoA (B) into the basilar artery with markedly improved flow across the stenotic lesion into the BA junction (C), bilateral PICA, and VA (E, F). *With permission from Chiam PT, Mocco J, Samuelson RM, Siddiqui AH, Hopkins LN, Levy EI: Retrograde angioplasty for basilar artery stenosis: bypassing bilateral vertebral artery occlusions. J Neurosurg 110:427-430, 2009*

Fig. 16. A 65-year old man presented with neck-movement-related VB insufficiency. The left VA was noted to be occluded extracranially. (A) Right VA (A) angiogram revealed excellent flow into the BA with fenestration (B), a tight stenosis at the junction (C) of the left VA (D) with the BA, and a peak systolic angiographic jet opacifying the PICA (E). (B) A microballoon (A) was brought from the right VA (C) over a wire, which was placed into the left proximal VA (B). (C) Final angiogram revealing significant improvement (despite persistent stenosis) in distal left VA (A) flow noted into the proximal left VA (B) and left PICA (C) following a right VA (D) injection. (E) Basilar artery.

Intracranial Arterial Collateralization: Relevance in Neuro-Endovascular Procedures 195

Fig. 19. A 65-year-old man presented with an acute stroke with occlusion of his left ICA. He was beyond the window for intravenous thrombolysis. His ancillary studies suggested potentially viable brain in the MCA territory. However, computed tomographic

angiography suggested occlusion of the left MCA territory in addition to more proximal carotid occlusion. An emergent angiogram was planned. (A) A right carotid (D) angiogram performed to assess cross-flow reveals a left ICA terminus occlusion (A) with flow to the bilateral distal ACA circulation across the ACoA (C) but no flow to the left MCA (B). (B) Selective left ICA angiogram reveals complete cavernous occlusion (B) of the left ICA (A). (C) The occlusion (B) was carefully crossed, and a thrombectomy suction catheter (A) was advanced into the occluded left MCA. (D) Following suction aspiration, the clot was retrieved from the MCA (B), resulting in revascularization of the ICA terminus (A) and reestablishment of flow across the ACoA (C) from the right ICA (F). Both ACAs remained patent (E, D). Despite these efforts, the proximal occlusion remained recalcitrant to revascularization efforts and was therefore left occluded. The patient recovered from all

deficits.

Fig. 17. A 44-year-old man with a Spetzler-Martin Grade IV AVM post-staged embolization and Gamma Knife radiosurgery presented with a residual, broad-based basilar terminus aneurysm. (A) Combined left carotid (E) and left VA (F) angiogram reveals a robust PCoA (C). BA (A), aneurysm (B), MCA (D). (B) Road-map image of an Enterprise stent (Codman Neurovascular) being deployed via the left ICA (E) through the left PCoA (F) from the ipsilateral P1 segment of the PCA (C) across the neck of the aneurysm into the contralateral PCA (B). Deployed stent markers (A). BA (D). (C) The patient was subsequently brought for a second coil embolization session with access to the BA aneurysm achieved from the left VA (C). Angiographically, complete aneurysm obliteration (A) was obtained. The left PCoA (B) is noted.

Fig. 18. A 40-year-old man presented with a history of a bullet injury to the head and neck and surgical ligation of the left ICA and now with acute development of a carotid-cavernous fistula. He was noted to have a ruptured, giant cavernous ICA pseudoaneurysm. (A) A left VA (A) angiogram reveals filling of the aneurysm (D) across the PCoA (C) to the supraclinoidal carotid artery (B) with early venous filling of the ophthalmic vein (F) and pterygoid venous plexus (E). (B) The aneurysm was accessed through the same route from the left VA (B) across the PCoA (C) to achieve complete obliteration of the aneurysm and carotid-cavernous fistula (A). MCA (D).

Fig. 17. A 44-year-old man with a Spetzler-Martin Grade IV AVM post-staged embolization and Gamma Knife radiosurgery presented with a residual, broad-based basilar terminus aneurysm. (A) Combined left carotid (E) and left VA (F) angiogram reveals a robust PCoA (C). BA (A), aneurysm (B), MCA (D). (B) Road-map image of an Enterprise stent (Codman Neurovascular) being deployed via the left ICA (E) through the left PCoA (F) from the ipsilateral P1 segment of the PCA (C) across the neck of the aneurysm into the contralateral PCA (B). Deployed stent markers (A). BA (D). (C) The patient was subsequently brought for a second coil embolization session with access to the BA aneurysm achieved from the left VA (C). Angiographically, complete aneurysm obliteration (A) was obtained. The left PCoA

Fig. 18. A 40-year-old man presented with a history of a bullet injury to the head and neck and surgical ligation of the left ICA and now with acute development of a carotid-cavernous fistula. He was noted to have a ruptured, giant cavernous ICA pseudoaneurysm. (A) A left

supraclinoidal carotid artery (B) with early venous filling of the ophthalmic vein (F) and pterygoid venous plexus (E). (B) The aneurysm was accessed through the same route from the left VA (B) across the PCoA (C) to achieve complete obliteration of the aneurysm and

VA (A) angiogram reveals filling of the aneurysm (D) across the PCoA (C) to the

carotid-cavernous fistula (A). MCA (D).

(B) is noted.

Fig. 19. A 65-year-old man presented with an acute stroke with occlusion of his left ICA. He was beyond the window for intravenous thrombolysis. His ancillary studies suggested potentially viable brain in the MCA territory. However, computed tomographic angiography suggested occlusion of the left MCA territory in addition to more proximal carotid occlusion. An emergent angiogram was planned. (A) A right carotid (D) angiogram performed to assess cross-flow reveals a left ICA terminus occlusion (A) with flow to the bilateral distal ACA circulation across the ACoA (C) but no flow to the left MCA (B). (B) Selective left ICA angiogram reveals complete cavernous occlusion (B) of the left ICA (A). (C) The occlusion (B) was carefully crossed, and a thrombectomy suction catheter (A) was advanced into the occluded left MCA. (D) Following suction aspiration, the clot was retrieved from the MCA (B), resulting in revascularization of the ICA terminus (A) and reestablishment of flow across the ACoA (C) from the right ICA (F). Both ACAs remained patent (E, D). Despite these efforts, the proximal occlusion remained recalcitrant to revascularization efforts and was therefore left occluded. The patient recovered from all deficits.

Intracranial Arterial Collateralization: Relevance in Neuro-Endovascular Procedures 197

Fig. 21. A 24-year-old man presented with subarachnoid hemorrhage due to proximal right PICA dissection. After superselective micro-balloon test occlusion, it was clear that there are

procedure. The distal branches remains filling after the proximal PICA occlusion. (A) Right

anastomoses from right SCA and AICA to right PICA distal branches. Therefore, the dissecting segment right PICA was successfully occluded with coils without the need of microsurgical bypass procedure, and the patient revealed no deficits following the

vertebral artery angiogram lateral view and (C) anterior-posterior view prior to the treatment. The *black arrows* point to the dissected proximal PICA. (B) Right vertebral artery angiogram lateral view and (D) anterior-posterior view after occlusion of proximal right PICA with coils. The *solid white arrows* indicate coil occlusion of the dissected proximal

PICA. *Open white arrows* indicate the distal right PICA filling from collaterals.

Fig. 20. A 42-year-old man presented with a ruptured ACoA aneurysm, which was treated via coil embolization. On Day 6, he developed severe symptomatic spasm, which remained refractory to maximal medical therapy. He had severe spasm of his left ACA, which resulted in the use of the ACoA artery as a conduit to angioplasty the left distal ACA. (A) Right carotid angiogram reveals a microcatheter and wire across the right ACA (A), AcoA, and aneurysm (C) into the left distal ACA (B). Right distal ACA (D). (B) Non-subtracted angiogram revealing the relationship of the aneurysm and the inflated balloon in the left distal ACA (A). AcoA (B), right distal ACA (C). Access microcatheter in the right ICA (D).

Fig. 20. A 42-year-old man presented with a ruptured ACoA aneurysm, which was treated via coil embolization. On Day 6, he developed severe symptomatic spasm, which remained refractory to maximal medical therapy. He had severe spasm of his left ACA, which resulted in the use of the ACoA artery as a conduit to angioplasty the left distal ACA. (A) Right carotid angiogram reveals a microcatheter and wire across the right ACA (A), AcoA, and aneurysm (C) into the left distal ACA (B). Right distal ACA (D). (B) Non-subtracted angiogram revealing the relationship of the aneurysm and the inflated balloon in the left distal ACA (A). AcoA (B), right distal ACA (C). Access microcatheter in the right ICA (D).

Fig. 21. A 24-year-old man presented with subarachnoid hemorrhage due to proximal right PICA dissection. After superselective micro-balloon test occlusion, it was clear that there are anastomoses from right SCA and AICA to right PICA distal branches. Therefore, the dissecting segment right PICA was successfully occluded with coils without the need of microsurgical bypass procedure, and the patient revealed no deficits following the procedure. The distal branches remains filling after the proximal PICA occlusion. (A) Right vertebral artery angiogram lateral view and (C) anterior-posterior view prior to the treatment. The *black arrows* point to the dissected proximal PICA. (B) Right vertebral artery angiogram lateral view and (D) anterior-posterior view after occlusion of proximal right PICA with coils. The *solid white arrows* indicate coil occlusion of the dissected proximal PICA. *Open white arrows* indicate the distal right PICA filling from collaterals.

Intracranial Arterial Collateralization: Relevance in Neuro-Endovascular Procedures 199

Fig. 23. Review of the circle of Willis appeared to demonstrate both a sizeable ACoA and PCoA arteries therefore a second groin access was established with the guide catheter in the vertebral artery (Figure 23 A, B). A microcatheter was used to catheterize the PCoA artery from the vertebral artery and thereby gain access into the aneurysm using retrograde catheterization of the proximally dislocated but distally tethered Pipeline Device (Figure

23 C, D).

Fig. 22. 64-year old woman presented with increasing headaches after a motor vehicle accident. She was neurologically intact upon presentation. Diagnostic workup revealed a giant cavernous aneurysm (Figure 22 A, B). She was enrolled in the PUFFs trial for utilization of a flow diversion Pipeline Device for treatment of large proximal carotid aneurysms. After deployment of the first device the distal access through the aneurysm was lost and despite multiple attempts to regain access through the proximal end of the stent, which had migrated laterally into the aneurysm, distal anterograde access could not be established (Figure 22 C, D).

Fig. 22. 64-year old woman presented with increasing headaches after a motor vehicle accident. She was neurologically intact upon presentation. Diagnostic workup revealed a giant cavernous aneurysm (Figure 22 A, B). She was enrolled in the PUFFs trial for utilization of a flow diversion Pipeline Device for treatment of large proximal carotid aneurysms. After deployment of the first device the distal access through the aneurysm was lost and despite multiple attempts to regain access through the proximal end of the stent, which had migrated laterally into the aneurysm, distal anterograde access could not be

established (Figure 22 C, D).

Fig. 23. Review of the circle of Willis appeared to demonstrate both a sizeable ACoA and PCoA arteries therefore a second groin access was established with the guide catheter in the vertebral artery (Figure 23 A, B). A microcatheter was used to catheterize the PCoA artery from the vertebral artery and thereby gain access into the aneurysm using retrograde catheterization of the proximally dislocated but distally tethered Pipeline Device (Figure 23 C, D).

Intracranial Arterial Collateralization: Relevance in Neuro-Endovascular Procedures 201

avoid complications that could have been prevented by a better understanding of underlying vascular anatomy. As the scope and extent of endovascular interventions for cerebrovascular and cranial disease continues to expand, the recognition of these putative anastomoses will continue to become a larger part of diagnostic evaluation and

[1] Agid R, Terbrugge K, Rodesch G, Andersson T, Soderman M: Management strategies for

[2] Albuquerque FC, Fiorella DJ, Han PP, Deshmukh VR, Kim LJ, McDougall CG:

[3] Berenstein A, Lasjaunias P, Kricheff, II: Functional anatomy of the facial vasculature in

[4] Capo H, Kupersmith MJ, Berenstein A, Choi IS, Diamond GA: The clinical importance of

[5] Casasco A, Houdart E, Biondi A, Jhaveri HS, Herbreteau D, Aymard A, et al: Major

[6] Chen PR, Ortiz R, Page JH, Siddiqui AH, Veznedaroglu E, Rosenwasser RH:

[7] Chiam PT, Mocco J, Samuelson RM, Siddiqui AH, Hopkins LN, Levy EI: Retrograde

[8] Countee RW, Vijayanathan T: External carotid artery in internal carotid artery occlusion. Angiographic, therapeutic, and prognostic considerations. Stroke 10:450-460, 1979 [9] Geibprasert S, Pongpech S, Armstrong D, Krings T: Dangerous extracranial-intracranial

[10] Hacein-Bey L, Daniels DL, Ulmer JL, Mark LP, Smith MM, Strottmann JM, et al: The

[11] Haffajee MR: A contribution by the ascending pharyngeal artery to the arterial supply of the odontoid process of the axis vertebra. Clin Anat 10:14-18, 1997 [12] Hallacq P, Piotin M, Moret J: Endovascular occlusion of the posterior cerebral artery for

[14] Larsen WJ: Development of Vasculature. New York (NY): Churchill Livingstone, 1997 [15] Lasjaunias P, Berenstein A, ter Brugge K: Surgical Neuroangiography: 1 Clinical

Vascular Anatomy and Variations. Berlin: Springer-Verlag, 2001

endovascular treatment. J Neurosurg 110:79-84, 2009

Neurosurg Focus 18:E3, 2005

Neuroradiol 20:179-181, 1999

occlusions. J Neurosurg 110:427-430, 2009

AJNR Am J Neuroradiol 23:1246-1256, 2002

AJNR Am J Neuroradiol 23:1128-1136, 2002 [13] Hayreh SS: Orbital vascular anatomy. Eye 20:1130-1144, 2006

4:149-153, 1983

63:256-265, 2008

2009

anterior cranial fossa (ethmoidal) dural arteriovenous fistulas with an emphasis on

Endovascular management of intracranial vertebral artery dissecting aneurysms.

pathologic conditions and its therapeutic application. AJNR Am J Neuroradiol

the inferolateral trunk of the internal carotid artery. Neurosurgery 28:733-738, 1991

complications of percutaneous embolization of skull-base tumors. AJNR Am J

Spontaneous systolic blood pressure elevation during temporary balloon occlusion increases the risk of ischemic events after carotid artery occlusion. Neurosurgery

angioplasty for basilar artery stenosis: bypassing bilateral vertebral artery

anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to nnow. AJNR Am J Neuroradiol doi 10.3174/ajnr.A1500; epub March 11,

ascending pharyngeal artery: branches, anastomoses, and clinical significance.

the treatment of p2 segment aneurysms: retrospective review of a 10-year series.

interventional design.

**7. References**

Fig. 24. Once the microwire was in the aneurysm a Snare was deployed to grab the microwire and the Marksman microcatheter was advanced using the snare over the microwire into the Pipeline device by pulling the microwire back out through the PCoA (Figure 24 A, B). Once distal access was reestablished additional Pipeline Devices were used to complete the endovascular reconstruction of the aneurysm. The aneurysm appeared almost completely obliterated at the end of the procedure (Figure 24 C) and remained obliterated at the 6-month follow-up (Figure 24 D).


*2.1. Materials*

Aniline was purchased from Across and distilled under vacuum. Acid Blue 40 dye, FeCl3·6H2O and Na2SO4 (Sigma-Aldrich, St. Louis, MO, USA), Dodecyl benzene sulfonic acid (DBSA) (Across) and FeSO4·7H2O (Merck, Kenilworth, NJ, USA ) were used without further purification.

### *2.2. Synthesis of PANI*

PANI was synthesized via our previously reported chemical oxidation method [49]. Typically, 0.02 M (1.182 mL) aniline was suspended in 50 mL of 0.01 M H2SO4 solution. To this suspension 0.01 M (0.15 mL) DBSA was added as an emulsifying agent. Then 50 mL of 0.01 M FeCl3·H2O prepared in 0.01 M H2SO4 was added drop by drop as an oxidant with constant stirring. After 20 min of continuous stirring, a milky white color suspension turned to light green and then dark green in one hour. The final product was thoroughly washed with acetone and then with double-distilled water until the filtrate became clear. The obtained powder was dried in an oven for 24 h at 60 ◦C.

### *2.3. Synthesis of Fe3O4*

Fe3O4 was synthesized by the chemical co-precipitation method by adding 0.15 mL DBSA and 2 M of FeCl3·6H2O dissolved in 50 mL of 0.1 M NaOH to 0.5 M FeSO4·7H2O solution. The whole mixture was stirred continuously at 85–90 ◦C. After 20 min of stirring, 30 mL of 5 M ammonia solution was added at once which turned the color of the reacting mixture to black. The pH of the reacting mixture was kept at 10 during the whole experiment. After two hours of continuous stirring at 85–90 ◦C, the precipitate was washed with ethanol and double distilled water until the effluent became clear. The black precipitate was dried at 80 ◦C for 10 h and then annealed at 600 ◦C for 5 h in a furnace (NEYCRAFT JFF 2000 Fiber Furnace, France).

### *2.4. Synthesis of PANI*/*Fe3O4 Composites*

PANI/Fe3O4 composites were synthesized by suspending 0.15 g Fe3O4 particles in 30 mL of 0.01 M H2SO4 solution followed by addition of 50 mL (0.02 M) of aniline solution prepared in 0.01 M H2SO4 and 0.5 mL (0.01) DBSA, respectively. After 30 min of continuous stirring, 50 mL of 0.01 M FeCl3·6H2O was added as an oxidizing agent. A light green color appeared within the stirring mixture after 20 min of the oxidant's addition. The color of this mixture turned dark black after about one hour. After continuously stirring for 6 h, the product was separated and washed with acetone and double-distilled water. The clean precipitate was dried in oven at 60 ◦C for 24 h.

### *2.5. Batch Adsorption Study for Removal of AB40 Dye*

Twenty-milliliter solutions of different concentrations between 5–120 mgL−1 were prepared from the stock solution of AB40 dye. To these solutions, PANI was added and shacked for about 120 min. These solutions were then filtered to determine the concentration of dye in the filtrate using UV-Visible spectrophotometer and applying Equation (1) [50].

$$\mathbf{q}\_{\mathbf{e}} = \frac{(\mathbf{C}\_{\mathbf{i}} - \mathbf{C}\_{\mathbf{e}})\mathbf{V}}{\mathbf{m}} \tag{1}$$

where qe (mg g−1) refers to adsorption at equilibrium, Ci (mg L−1) and Ce (mg L−1) show initial and equilibrium concentration of dye, respectively, m (g) is the mass of adsorbent while V represents the volume of solution in mL. The e ffect of temperature, contact time, ionic strength, pH and initial concentration of dye solution on the adsorption behavior was studied. The adsorption data were utilized to calculate the thermodynamic and kinetics parameters. The same procedure was employed for studying adsorption of AB40 on Fe3O4 and PANI/Fe3O4 composite.

Before the adsorption process, standard solutions of AB40 dye were prepared was in the range 0.005–2 mg L−1 and their maximum absorption was determined via UV-Visible spectrophotometer (Perkin Elmer, Waltham, MA, USA). The absorption values were plotted against concentration of the standard dye solutions and calibration curve was obtained according to the Beer–Lambert law. The slope so obtained was used as reference for the determination of concentration in rest of the experiments. The calibration curve is also shown in the supporting files (Figure S1).

After the adsorption of AB40 dye, the adsorbents were put onto the filter paper and washed several times with double-distilled water to run out the adsorbed dye. Then it was washed with 0.1 M NaOH to remove the remaining dye. This process enables the reutilization of the adsorbent.