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We report our experience with Günter Tulip filter placement indications, retrievals, and procedural problems, with emphasis on alternative retrieval techniques. We have identified 92 consecutive patients in whom a Günter Tulip filter was placed and filter removal attempted. We recorded patient demographic information, filter placement and retrieval indications, procedures, standard and nonstandard filter retrieval techniques, complications, and clinical outcomes. The mean time to retrieval for those who experienced filter strut penetration was statistically significant [F(1,90) = 8.55, p = 0.004]. Filter strut(s) IVC penetration and successful retrieval were found to be statistically significant (p = 0.043). The filter hook-IVC relationship correlated with successful retrieval. A modified guidewire loop technique was applied in 8 of 10 cases where the hook appeared to penetrate the IVC wall and could not be engaged with a loop snare catheter, providing additional technical success in 6 of 8 (75%). Therefore, the total filter retrieval success increased from 88 to 95%. In conclusion, the Günter Tulip filter has high successful retrieval rates with low rates of complication. Additional maneuvers such as a guidewire loop method can be used to improve retrieval success rates when the filter hook is endothelialized.

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information required for accurate ICD-10-CM coding and the ways in which the required documentation differs from ICD-9-CM using examples specific to IR. We will also present strategies to improve accurate CPT and ICD-10 coding, including communication with coding teams and a structured template for E&M notes. A sample template which has been developed to be helpful to referring colleagues and professional coders while incorporating the requirements of the CPT codes for billing purposes will be included. Conclusions: Appropriate documentation of E&M services helps form relationships with referring physicians and can increase revenue at a time when reimbursement for procedures continues to decline. Accurate ICD-10-CM and CPT coding can be achieved through a better understanding of the terminology requirements, collaboration with coding teams and use of templates. References 1. CDC. International Classification of Diseases, (ICD-10-CM/PCS) transition.

To report a single-center experience of the technical success and clinical 90-day outcomes of MT for anterior circulation ELVOs performed by interventional radiologists. Materials: A retrospective review identified 178 consecutive patients from January 2016 to March 2018 who underwent MT for anterior circulation ELVOs within 6 hours of symptom onset and initial NCCT ASPECTS 6, or presenting >6 hours but further selected with CT perfusion. Eight interventional radiologists performed the procedures. Technical and clinical outcomes were compared to the HERMES dataset. Results: Eight patients were excluded for spontaneous revascularization. The average age was 66 years versus 68 years for HER-MES. The average NIHSS was 17 for both groups. Vessel occlusions included: M1 59% (100/170) versus 69% (439/633), M2 12% (20/ 170) versus 8.0% (51/633), ICA 29% (50/170) versus 21% (133/ 633), and tandem ICA origin/M1 17% (29/170) (not reported in all trials), respectively. The overall mTICI 2b/3 reperfusion rate was 87% (148/170) versus 72% (405/633), respectively (p<0.05). The mRS 90-day outcome 0-2 rate was 40% (68/170) versus 46% (223/ 645), respectively (p¼0.14). Major procedural complications were 3.5% (6/171) including 2 ICA dissections, 1 M2 MCA air embolization, 1 MCA wire perforation, 1 femoral hematoma requiring transfusion, and 1 anaphylaxis. Symptomatic intracranial hemorrhage rate was 4.1% (7/171) versus 4.4% (28/633), respectively. Conclusions: This single-center experience describes similar technical success and 90-day outcomes for MT of anterior ELVOs by interventional radiologists to the HERMES data set.