bluuebunny/crossref_metadata_2025 huggingface dataset:
Supplemental Figure S4 from The EP3–ZNF488 Axis Promotes Self-Renewal of Glioma Stem-Like Cells to Induce Resistance to Tumor Treating Fields
Authors: Chen Dongjiang , Le Son B. , Manektalia Harshit , Liu Tianyi , Hutchinson Tarun E. , O’Dell Adam , Salhia Bodour , Tran David D.
Published: January 2025

Characterization of TTFields-resistant GSC. (Supporting Main Figure 1H-K)
Supplementary Table 4 from FOXR2 Targets LHX6+/DLX+ Neural Lineages to Drive Central Nervous System Neuroblastoma
Authors: Jessa Selin , De Cola Antonella , Chandarana Bhavyaa , McNicholas Michael , Hébert Steven , Ptack Adam , Faury Damien , Tsai Jessica W. , Korshunov Andrey , Phoenix Timothy N. , Ellezam Benjamin , Jones David T.W. , Taylor Michael D. , Bandopadhayay Pratiti , Pathania Manav , Jabado Nada , Kleinman Claudia L.
Published: January 2025

Quality control metrics and processing parameters for single-cell data for patient tumors.
Supplementary Table 2 from FOXR2 Targets LHX6+/DLX+ Neural Lineages to Drive Central Nervous System Neuroblastoma
Authors: Jessa Selin , De Cola Antonella , Chandarana Bhavyaa , McNicholas Michael , Hébert Steven , Ptack Adam , Faury Damien , Tsai Jessica W. , Korshunov Andrey , Phoenix Timothy N. , Ellezam Benjamin , Jones David T.W. , Taylor Michael D. , Bandopadhayay Pratiti , Pathania Manav , Jabado Nada , Kleinman Claudia L.
Published: January 2025

Summary of patient samples included in this study, and profiling by RNAseq, scRNAseq, or scMultiome.
Supplementary Figure 5 from FOXR2 Targets LHX6+/DLX+ Neural Lineages to Drive Central Nervous System Neuroblastoma
Authors: Jessa Selin , De Cola Antonella , Chandarana Bhavyaa , McNicholas Michael , Hébert Steven , Ptack Adam , Faury Damien , Tsai Jessica W. , Korshunov Andrey , Phoenix Timothy N. , Ellezam Benjamin , Jones David T.W. , Taylor Michael D. , Bandopadhayay Pratiti , Pathania Manav , Jabado Nada , Kleinman Claudia L.
Published: January 2025

NB-FOXR2 tumors transcriptionally resemble interneurons and oligodendrocyte precursor cells.
Supplementary Figure 4 from FOXR2 Targets LHX6+/DLX+ Neural Lineages to Drive Central Nervous System Neuroblastoma
Authors: Jessa Selin , De Cola Antonella , Chandarana Bhavyaa , McNicholas Michael , Hébert Steven , Ptack Adam , Faury Damien , Tsai Jessica W. , Korshunov Andrey , Phoenix Timothy N. , Ellezam Benjamin , Jones David T.W. , Taylor Michael D. , Bandopadhayay Pratiti , Pathania Manav , Jabado Nada , Kleinman Claudia L.
Published: January 2025

Bulk RNAseq projections by ssGSEA.
Figure 6 from FOXR2 Targets LHX6+/DLX+ Neural Lineages to Drive Central Nervous System Neuroblastoma
Authors: Jessa Selin , De Cola Antonella , Chandarana Bhavyaa , McNicholas Michael , Hébert Steven , Ptack Adam , Faury Damien , Tsai Jessica W. , Korshunov Andrey , Phoenix Timothy N. , Ellezam Benjamin , Jones David T.W. , Taylor Michael D. , Bandopadhayay Pratiti , Pathania Manav , Jabado Nada , Kleinman Claudia L.
Published: January 2025

Mouse models transcriptomically recapitulate human NB-FOXR2. A, Heatmap showing CNVs in Foxr2 p53LOF and Foxr2 alone models, computed with inferCNV. B, Top, Uniform Manifold Approximation and Projection (UMAP) joint representation of mouse model single-cell datasets (n = 3) without integration or batch correction. Cells colored by broad cell class derived from automated cell type annotation, with nonmalignant cells colored in gray. Bottom, bar plot quantification of number of cells per group in UMAP. C, Volcano plots of differentially expressed genes between bulk RNA-seq tumors in NB-FOXR2 compared with MB-WNT, DIPG-H3K27M, and embryonal tumors with multilayered rosettes (ETMR) groups. Points colored in red are the top 100 differentially expressed genes in common across comparisons, used as a tumor signature of NB-FOXR2. D, Validation of tumor signature expression specificity in each tumor type. Heatmap showing bulk RNA expression of tumor signature genes (rows) in each tumor sample (columns). Row values are Z-scored. E, UMAP joint representation of mouse models as in B, with malignant neuron-like cells colored by the ssGSEA score of each tumor signature. F, Distribution of tumor signature ssGSEA scores in malignant neuron-like cells of murine models. Each row is one sample. Adj, adjusted; chr, chromosome; DIPG-H3K27M, DIPG, H3K27M altered; MB-WNT, WNT medulloblastoma.
Figure 2 from FOXR2 Targets LHX6+/DLX+ Neural Lineages to Drive Central Nervous System Neuroblastoma
Authors: Jessa Selin , De Cola Antonella , Chandarana Bhavyaa , McNicholas Michael , Hébert Steven , Ptack Adam , Faury Damien , Tsai Jessica W. , Korshunov Andrey , Phoenix Timothy N. , Ellezam Benjamin , Jones David T.W. , Taylor Michael D. , Bandopadhayay Pratiti , Pathania Manav , Jabado Nada , Kleinman Claudia L.
Published: January 2025

NB-FOXR2 expresses a TF fingerprint of the MGE. A, Expression of telencephalon-patterning TFs in the embryonal mouse brain. Top, stereo-seq in situ RNA expression of telencephalon-patterning TFs in E14 mouse (Chen and colleagues, ref. 75; https://db.cngb.org/stomics/mosta/spatial/). Middle, RNA in situ hybridization in E13 mouse (Allen Brain Atlas, https://developingmouse.brain-map.org/). Bottom, schematic of the mouse brain (sagittal section) at E13, and schematized expression of each TF in the telencephalon. B, Evaluation of SVM-based classification of neuron clusters from normal fetal and adult brain scRNA-seq datasets based on expression levels of telencephalon-patterning TFs in each cluster. Precision and recall metrics are calculated across clusters in each class in each dataset and are shown for each fold of a four-fold cross-validation experiment (one point per fold) for the adult datasets. Top, adult human dataset; bottom, adult mouse dataset. C, Expression of telencephalon TF fingerprint across normal brain and tumor datasets. Left, expression in clusters of single cells from reference datasets of the human and mouse fetal and adult brains aggregated by class (dorsal, CGE/LGE, and MGE). Scaling was performed within each dataset. Human 1, data from Yu and colleagues (38). Human 2, data from Shi and colleagues (39). Middle, expression in NB-FOXR2 tumors profiled by bulk RNA-seq and in malignant cells of NB-FOXR2 tumors profiled by scRNA-seq. For single-cell tumors, scaling was performed between malignant and normal cells of the same sample (normal cells not shown). For bulk RNA-seq, bubble size encodes log10-transformed median normalized expression across samples in each brain tumor subtype. Right, expression in other brain tumors profiled by bulk RNA-seq. DIPG-H3K27M-FOXR2, DIPG, H3K27M altered, and FOXR2 activated; DIPG-H3K27M, DIPG, H3K27M altered; EP-PFA, posterior fossa group A ependymoma; ETMR, embryonal tumors with multilayered rosettes; HGG-IDH, HGG, IDH-mutant; HGG-H3.3G34R/V, HGG, H3.3G34R/V altered; MB-SHH, SHH medulloblastoma; MB-WNT, WNT medulloblastoma.
Supplementary Figure 5 from KRAS Loss of Heterozygosity Promotes MAPK-Dependent Pancreatic Ductal Adenocarcinoma Initiation and Induces Therapeutic Sensitivity to MEK Inhibition
Authors: Fey Sigrid K. , Najumudeen Arafath K. , Watt Dale M. , Millett Laura M. , Ford Catriona A. , Gilroy Kathryn , Simpson Rosalin J. , McLay Kathy , Upstill-Goddard Rosanna , Chang David , Clark William , Nixon Colin , Birch Joanna L. , Barry Simon T. , Morton Jennifer P. , Campbell Andrew D. , Sansom Owen J.
Published: January 2025

Loss of wild-type KRAS sensitizes KPC KrasG12D/fl tumours to MEK1/2 inhibition.
Figure 2 from KRAS Loss of Heterozygosity Promotes MAPK-Dependent Pancreatic Ductal Adenocarcinoma Initiation and Induces Therapeutic Sensitivity to MEK Inhibition
Authors: Fey Sigrid K. , Najumudeen Arafath K. , Watt Dale M. , Millett Laura M. , Ford Catriona A. , Gilroy Kathryn , Simpson Rosalin J. , McLay Kathy , Upstill-Goddard Rosanna , Chang David , Clark William , Nixon Colin , Birch Joanna L. , Barry Simon T. , Morton Jennifer P. , Campbell Andrew D. , Sansom Owen J.
Published: January 2025

Early intervention with AZD6244 reduces PanIN burden in KrasG12D/fl mice. A, Experimental schematic. KC KrasG12D/fl were treated from day 42 for 28 days with vehicle or AZD6244 and sampled at day 70. B, Representative hematoxylin and eosin (H&E), pERK1/2, and Ki67 IHC images from pancreata of KC KrasG12D/fl mice at 70 days of age following treatment with vehicle or AZD6244 as indicated for 28 days. Representative of four mice per group. Scale bar, 200 μm. C, Quantification and grading of PanINs from pancreata of KC KrasG12D/+ and KC KrasG12D/fl mice treated with vehicle or AZD6244 from 42 to 70 days of age, scored from whole hematoxylin and eosin sections (n = 4 per group). Boxes depict the IQR, the central line indicates the median, and whiskers indicate minimum/maximum values. D, Quantification of the area of ADM per mm2 pancreas over one whole hematoxyly and eosin section from pancreata of KC KrasG12D/fl mice treated as indicated from day 42 for 28 days (n = 4 per group). Boxes depict the IQR, the central line indicates the median, and whiskers indicate minimum/maximum values. Comparison by one-way Mann–Whitney U test. E, Representative images of c-MYC IHC and Dusp6 ISH of KC KrasG12D/fl mice treated with vehicle or AZD6244 as indicated from day 42 for 28 days. Representative of four mice per group. Scale bar, 200 μm.
Data from FOXR2 Targets LHX6+/DLX+ Neural Lineages to Drive Central Nervous System Neuroblastoma
Authors: Jessa Selin , De Cola Antonella , Chandarana Bhavyaa , McNicholas Michael , Hébert Steven , Ptack Adam , Faury Damien , Tsai Jessica W. , Korshunov Andrey , Phoenix Timothy N. , Ellezam Benjamin , Jones David T.W. , Taylor Michael D. , Bandopadhayay Pratiti , Pathania Manav , Jabado Nada , Kleinman Claudia L.
Published: January 2025

Abstract
Central nervous system neuroblastoma with forkhead box R2 (FOXR2) activation (NB-FOXR2) is a high-grade tumor of the brain hemispheres and a newly identified molecular entity. Tumors express dual neuronal and glial markers, leading to frequent misdiagnoses, and limited information exists on the role of FOXR2 in their genesis. To identify their cellular origins, we profiled the transcriptomes of NB-FOXR2 tumors at the bulk and single-cell levels and integrated these profiles with large single-cell references of the normal brain. NB-FOXR2 tumors mapped to LHX6+/DLX+ lineages derived from the medial ganglionic eminence, a progenitor domain in the ventral telencephalon. In vivo prenatal Foxr2 targeting to the ganglionic eminences in mice induced postnatal cortical tumors recapitulating human NB-FOXR2–specific molecular signatures. Profiling of FOXR2 binding on chromatin in murine models revealed an association with ETS transcriptional networks, as well as direct binding of FOXR2 at key transcription factors that coordinate initiation of gliogenesis. These data indicate that NB-FOXR2 tumors originate from LHX6+/DLX+ interneuron lineages, a lineage of origin distinct from that of other FOXR2-driven brain tumors, highlight the susceptibility of ventral telencephalon–derived interneurons to FOXR2-driven oncogenesis, and suggest that FOXR2-induced activation of glial programs may explain the mixed neuronal and oligodendroglial features in these tumors. More broadly, this work underscores systematic profiling of brain development as an efficient approach to orient oncogenic targeting for in vivo modeling, critical for the study of rare tumors and development of therapeutics.

Significance: Profiling the developing brain enabled rationally guided modeling of FOXR2-activated CNS neuroblastoma, providing a strategy to overcome the heterogeneous origins of pediatric brain tumors that hamper tumor modeling and therapy development.

See related commentary by Orr, p. 195
Supplementary Data from First-in-Human Study of 23ME-00610, an Antagonistic Antibody for Genetically Validated CD200R1 Immune Checkpoint, in Participants with Advanced Solid Malignancies
Authors: Kummar Shivaani , Razak Albiruni Abdul , Laurie Scott , Glatt Dylan M. , Kell Sariah , Diep Anh N. , Schmidt Maike , Hom Clifford , German Chris , Shringarpure Suyash S. , Majeed Sophia R. , Rasco Drew
Published: January 2025

Supplemental_all tables and figures
Figure S2 from First-in-Human Study of 23ME-00610, an Antagonistic Antibody for Genetically Validated CD200R1 Immune Checkpoint, in Participants with Advanced Solid Malignancies
Authors: Kummar Shivaani , Razak Albiruni Abdul , Laurie Scott , Glatt Dylan M. , Kell Sariah , Diep Anh N. , Schmidt Maike , Hom Clifford , German Chris , Shringarpure Suyash S. , Majeed Sophia R. , Rasco Drew
Published: January 2025

Supplemental Figure S2
Elementos mundializados em narrativas de streaming: padronização e cultura de séries em Young Royals, Wandinha e Sex Education
Authors: Fanfa Mauricio de Souza , Ribeiro Ana Clara Lima , Fonseca Mar Rodrigues
Published: January 2025

Este artigo analisa elementos de narrativas de streaming para identificar características promotoras de mundialização atuais da cultura de séries. São analisadas as séries Young Royals, Wandinha e Sex Education. A postura teórico-metodológica deste trabalho é derivada da análise cultural de produtos audiovisuais. São realizados apontamentos sobre idiomas, representações de migrantes e estrangeiros, estrutura escolar, sexualidade e hábitos de consumo. Identificamos uma perceptível padronização em representação de estereótipos, ambientações, elementos estéticos e elementos narrativos em tais séries, característicos de novos modos de mundialização das narrativas seriadas do streaming.
A série policial Bom dia, Verônica: intermidialidade, hibridação narrativa e a mediação cultural local-global
Authors: Gonçalves Carlos Pereira
Published: January 2025

This study proposes to critically analyze the first season of Bom dia, Verônica (2020), a Netflix co-production with the Zola Filmes company, which was created by crime writers Raphael Montes and Ilana Casoy based on the homonymous novel and directed by and videomaker filmmaker José Henrique Fonseca. This study aims to discuss three media and narratological approaches: the social and aesthetic process of intermediality in SVoD platforms; the genres and the narrative hybridization question; and local-global cultural mediation.
A circulação e as interpretações políticas de Que horas ela volta?
Authors: Sousa Eduardo Paschoal de
Published: January 2025

This study aims to analyze the critical and political circulation of the movie Que horas ela volta? (The second mother, Anna Muylaert, 2015) since its first release. Based on reactions to the film, including its consecutive screenings on TV, we aimed to map its recurring interpretations. For this, we employed two theoretical-methodological concepts: anchoring — the way in which the film dialogues with political and social debates based on its representations and circulations — and coupling — the reactions of spectator groups who connect to the movie, construct new interpretations about it, or mobilize already present ones circulating in the critical and media spheres.
A crítica cinematográfica nos filmes brasileiros Benzinho e A mãe
Authors: Mello Cecília , D'Alama Luna Gonçalves
Published: January 2025

This study analyzes three journalistic reviews of the film Benzinho (2018), directed by Gustavo Pizzi, and another three of the film A Mãe (2022), by Cristiano Burlan, that were published in the mainstream media by critics such as Luiz Carlos Merten (O Estado de S. Paulo), Eduardo Escorel (piauí), and Flavia Guerra (UOL). To better elucidate this scenario, it introduces concepts from Pareyson on art critique; from Silva and Soares, and from Paganotti and Soares on media critique; and from Xavier on film critique. Its conclusions point to the still low participation of women and other minority majorities in the specialized criticism of the major media and to the importance of the return of screen quotas — which Bolsonaro government interrupted in 2021 and Lula government resumed in 2024 — to value Brazilian cinema.
Abstract 015: Evaluation of the CEREGLIDE 92 Catheter, a Novel Super‐Bore Aspiration Catheter: SPLENDID Trial Methods
Authors: Froehler M. , Jankowitz B. , Al-Mufti F. , Grandhi R. , Gutierrez S. Ortega , Rai A.
Published: January 2025

Introduction/Purpose

Mechanical thrombectomy (MT) with a direct aspiration first pass technique (ADAPT) has demonstrated similar reperfusion rates and clinical outcomes as MT using stent retrievers. Super bore catheters have larger inner diameters (ID) that are more closely matched to the vessel ID to provide more suction capability when compared to existing large bore aspiration catheters. The purpose of the SPLENDID study is to evaluate the safety and effectiveness of CEREGLIDE 92 Catheter (largest 8F catheter designed for intracranial access) in the treatment of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) within the internal carotid, middle cerebral‐M1 segment, basilar, and vertebral arteries up to 24hrs.

Methods

SPLENDID is a prospective, multicenter, single arm, IDE trial that will enroll up to 140 subjects at up to 25 sites. CEREGLIDE 92 will be used for direct aspiration as the first attempted MT device/technique. Follow‐up will occur at 24 hours, 7 days (or discharge), and 90 days post‐procedure. An Imaging Core Lab, blinded independent evaluation of 90‐day modified Rankin Scale (mRS), Clinical Events Committee (CEC) and Data Monitoring Committee (DMC) will be used.

Results

The primary effectiveness endpoint will be first pass reperfusion (eTICI≥2b50 without additional therapy) per the Imaging Core Lab. Secondary effectiveness endpoints will be 90‐day mRS 0‐2, time to reperfusion, first pass reperfusion (eTICI≥2c without additional therapy), final procedural reperfusion (eTICI≥2c), final procedural reperfusion (eTICI 3), and embolization in new territory. Secondary safety endpoints will include 90‐day all‐cause mortality, 24‐hour symptomatic intracranial hemorrhage per CEC, and serious adverse device effects through 30 days per CEC. Health value endpoints will include hospitalization length of stay, healthcare resource utilization, and 90‐day patient‐reported Quality of Life using the PROMIS‐10.

Conclusion

SPLENDID will prospectively evaluate the clinical impact of super large bore aspiration using the CEREGLIDE 92 Catheter for direct aspiration as the first attempted MT technique and is the first IDE (investigational device exemption) study to use first‐pass effect as the primary endpoint.
Abstract 066: Adaptive and physiological cerebrovascular changes at high altitudes: a systematic review and meta‐analysis
Authors: Chirinos J. M. Sequeiros , Zila-Velasque P. , Grados-Espinoza P. , Abanto-Urbano S. , Olarte-Durand M. , Vilca-Salas M. , Moran-Ballon P. , Velasquez-Rimachi V. , Regalado-Rodríguez K. , Quispe-Vicuña C. , Terry F. , Alva-Diaz C.
Published: January 2025

Introduction

moderate altitude, considered over 1,500 meters (about 4921 ft) above sea level (m.a.s.l), is a particular environment due to the lower oxygen pressure that conditions the development of adaptive mechanisms such as cerebrovascular changes expressed in cerebral blood flow (CBF). Several studies have explored changes in CBF in small populations, however, changes at different altitudes, populations and units of measurement have not been described. These characteristics have been associated with cerebrovascular adaptation

Methods

We systematically searched databases (PubMed‐Medline, Embase, Web of Science, Scopus and Google Scholar) until January 2022 for studies evaluating cerebrovascular changes resulting from exposures at altitudes greater and lower than 1500 m.a.s.l. The Newcastle‐Ottawa scale and RoB‐2 tools was used to assess the risk of bias from observational studies and randomized clinical trials, respectively. A meta‐analysis using a random‐effects model to estimate pooled effects was realized for each outcome and a narrative synthesis when this was not possible. GRADE criteria were used to identify the certainty of evidence for each result.

Results

We included 58 studies (2 randomized clinical trials and 56 non‐randomized clinical trials) with 1959 patients. Most studies were at low risk of bias. We found that in the middle meningeal artery, altitude higher than 1500 m.a.s.l may reduce autoregulatory index (MD −0.42, 95% CI −0.67 to −0.18, I2 84%, 2 studies, low certainty), cerebral oxygen saturation (MD −5.65, 95% CI −8.63 to −2.67, I2 91%), cerebral oxygen saturation (MD −5.65, 95% CI ‐8.63 to ‐2.67, I2 91%) and cerebral oxygen saturation (MD ‐5.65, 95% CI ‐8.63 to ‐2.67, I2 91%): ‐8.63 to ‐2.67, I2: 91%, 3 studies, low certainty), cerebrovascular resistance (MD: ‐25.04, 95% CI: ‐75.61 to 25.54, I2: 100%, 2 studies, low certainty) and Cerebrovascular Conductance (MD: ‐0.01, 95% CI: ‐0.05 to 0.03, I2: 0%, 2 studies, low certainty). Similarly, in the internal carotid and vertebral artery, altitude may increase global cerebral blood flow (MD 200.82, 95% CI 47.17 to 354.46, I2 70%, 2 studies, low certainty).

Conclusion

Exposure to altitudes above 1500 m.a.s.l reduces autoregulation and cerebral oxygen saturation but increases overall cerebral blood flow. These changes could indicate cerebrovascular adaptations to lower oxygen pressures, although the evidence is of low certainty due to variability between studies.
Abstract 086: Design and validation of a scale for the prediction of large vessel occlusion in stroke patients in the Latin American population Escala Predictiva en Ictus de Oclusion EsPIO
Authors: Huamani C. , Rosales-Amaya A. , Moreno-Arias J. , Mercado-Pompa A. A. , López-Mena D. , Gutiérrez-Romero A. , Aburto-Murrieta Y.
Published: January 2025

Introduction

There are multiple limitations in the approach and management of ischemic stroke in the Latin American people, particularly, in the management of patients requiring thrombectomy. Although there are numerous scales to predict large vessel occlusion (LVO), they have not been validated in this population; therefore, our objective was to design and validate a scale to predict large vessel occlusion in this populace, in order to provide predictive tools for the decision making in the stroke patients.

Methods

A multivariate logistic regression model was constructed from the National Institutes of Health Stroke Scale (NIHSS) items, using the backward stepwise methodology to select the items that best predicted the model, eliminating items with p ≥ 0.05. The significant items comprised the EsPIO (
Escala Precdictiva en Ictus de Oclusión,
i.e. Occlusion Prediction Scale in Stroke). For its creation, we use a validation cohort with the 66% of patients, in whom neuroimaging was performed to assess cervical and cerebral vessels. Sensitivity, specificity, ROC curves, positive predictive value (PPV) and negative predictive value (NPV) were evaluated. The remaining 33% of the cohort was used for a validation cohort. Finally, the results of derivation and the validation cohort in the EsPIO scale were compared.

Results

We included 668 patients; LVO was identified in 15.5%. In the validation cohort, the four significant items were gaze disturbance, arm motor function, language, and extinction or inattention, with which the EsPIO scale was constructed, ranging from 0 to 11 points. With >=3 points, it had a sensitivity (S) of 89% and specificity (E) of 46%, with >=4 points it had S 85% and E 60%, choosing this point, PPV 19%, and NPV 97% when the frequency was 10%. The ROC curve was 0.831 (95%CI 0.771‐0.891). The derivation and validation cohort were compared, with no significant differences.

Conclusion

The results obtained with the creation of the EsPIO scale show very high negative predictive values. This scale may aid in determining which patients may benefit from being translated to thrombectomy‐capable centers.
Abstract 110: Impact of Neuroimaging Markers on Clinical Outcomes in Cerebral Amyloid Angiopathy‐Related Intracerebral Hemorrhage
Authors: Das A. S. , Fouks A. Abramovitz , Gökçal E. , Rotschild O. , Regenhardt R. W. , Selim M. H. , Viswanathan A. , Goldstein J. N. , Rosand J. , Greenberg S. M. , Gurol M. E.
Published: January 2025

Introduction/Purpose

The recent update (version 2.0) to the Boston criteria for cerebral amyloid angiopathy (CAA) adds two additional neuroimaging markers to increase the sensitivity of CAA detection: multispot white matter hyperintensity (WMH) pattern and severe centrum semiovale enlarged perivascular spaces (CSO EPVS). While the presence of these novel non‐hemorrhagic markers, together with well‐established hemorrhagic markers such as lobar cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS), increases the likelihood of underlying CAA in patients with intracerebral hemorrhage (ICH), it is unclear whether these markers have a prognostic impact on clinical outcomes.

Materials/Methods

Brain MRIs from a prospective database of consecutive non‐traumatic ICH patients admitted to a tertiary care center were reviewed for the presence of CMBs, cSS, multispot WMH pattern, and CSO EPVS. Patients who met the diagnostic criteria for CAA were selected for inclusion in this study. Clinical and neuroimaging predictors of an unfavorable discharge outcome (modified Rankin score ≥ 4) were assessed in univariate and multivariable models.

Results

Between 2003 and 2019, 1,791 patients were admitted with non‐traumatic ICH. Of the 1,297 (72%) patients who received a brain MRI, 645 (36%) were found to have CAA (mean age 74±11 years, 49% female). An unfavorable outcome was observed in 75% of patients. Lobar CMBs occurred in 326 (51%) patients, cSS occurred in 197 (31%), multispot WMH pattern occurred in 123 (19%), and severe CSO EPVS occurred in 156 (24%). In univariate analyses, age, hypertension, diabetes, ischemic stroke history, dementia, admission Glasgow Coma Scale (GCS) scores, intubation, external ventricular drain placement, hematoma evacuation, intraventricular extension, and cSS were associated with an unfavorable discharge outcome (all
p
< 0.05). When entered into a multivariable model subjected to backward elimination, age (aOR 1.05, 95% CI 1.03‐1.08), hypertension (aOR 1.66, 95% CI 1.06‐2.62), dementia (aOR 8.40, 95% CI 1.97‐35.81), GCS score (aOR 0.85, 95% CI 0.75‐0.96), intubation (aOR 2.59, 95% CI 1.09‐6.15), intraventricular extension (aOR 1.75, 95% CI 1.67‐4.84), and cSS (aOR 1.75, 95% CI 1.07‐2.88) remained significantly associated with an unfavorable discharge outcome.

Conclusion

Although non‐hemorrhagic imaging markers are common in CAA patients with ICH, only the presence of cSS is significantly associated with unfavorable clinical outcomes.
Abstract 117: Intravenous Cangrelor Use in Patients with Intracranial Hemorrhage
Authors: Tolba H. , Khan M. , Fakih R. , Gillani S. , Gomez C. R. , Qureshi A. I.
Published: January 2025

Introduction

Cangrelor is an intravenous (IV), direct‐acting, and reversible P2Y12 inhibitor with rapid onset and offset. Hence, use of Cangrelor in cerebrovascular interventions has recently expanded. We report our experience with IV Cangrelor in patients with intracranial hemorrhage who required antiplatelet medication to avoid stent thrombosis.

Methods

We reviewed the available computed tomographic (CT) images before, during, and after completion of IV Cangrelor infusion to identify any increase in intracranial hemorrhage. We also ascertained any neurological deterioration (defined by increase in NIH stroke scale of ≥4 points) and occurrence of new thromboembolic events.

Results

Four patients we switched from oral P2Y12 inhibitors to IV Cangrelor due to new‐onset intracranial hemorrhage. Two patients had stents placed in cervical Internal Carotid Arteries during thrombectomy, one patient underwent stent placement in vertebral artery during thrombectomy, and one patient underwent stent assisted coiling for internal carotid artery aneurysm. Post‐procedural mean time to initiate IV Cangrelor infusion was 6 days (SD=7.6 days). All patients received a bolus of 5mcg/kg of Cangrelor followed by 1mcg/kg/min maintenance dose for a mean period of 5.8 days (SD=3.3 days). Serial CT scans of head were obtained after initiation of IV Cangrelor in 3 patients (mean number of scans was 3.7), None of the patients experienced either neurological deterioration or worsening of the intracranial hemorrhage during follow up. Three out of four patients underwent repeat vascular imaging, documenting no stent thrombosis or occlusion.

Results

Use of IV Cangrelor infusion appears to be safe in patients with intracranial hemorrhage in whom platelet inhibition is necessary to avoid stent thrombosis.
Abstract 128: Outcomes of Intervention versus Medical Management Alone for Infectious Intracranial Aneurysms ‐ A Nationwide Analysis
Authors: Ehidom C.
Published: January 2025

Introduction

Infectious intracranial aneurysms (IIA) are one of several cerebrovascular complications associated with infective endocarditis (IE). IIA are initially treated with antibiotics given that treatment of the underlying infection is an important component of therapy. However, given the complex nature of these aneurysms, a multi‐disciplinary approach may be warranted for optimal outcomes, which includes coiling, embolization, clipping, or a combination of these measures. Herein, we aim to better understand outcomes in the use of medical management alone in this group of patients versus additional interventions.

Methods

Using data from the National Inpatient Sample from 2000 to 2020, we conducted an analysis comparing outcomes of intervention with medical management versus medical management alone for hospitalizations with infective endocarditis. A subgroup analysis of ruptured vs unruptured aneurysms was performed with primary endpoints being mortality and favorable outcome defined as discharge disposition to home without services. Treatment modalities were categorized as antibiotics, endovascular, and/or open neurosurgical repair based on ICD‐9 and ICD‐10 codes. Logistic regressions were utilized to assess the association between treatment modality and the outcomes of in‐hospital mortality and discharge disposition, while accounting for age and illness severity [quantified by All Patient Refined Diagnostic Related Groups (APR‐DRG) illness severity subclass]. Effect size was reported as adjusted odds ratio (aOR) with 95% confidence interval (CI).

Results

This analysis identified 2711 hospitalizations for IE, of which 315 (11.6%) were treated with antibiotics alone, versus 2715 (88.4%) which were treated with both antibiotics and intervention. IE patients undergoing intervention experienced significantly decreased mortality rates in comparison to those receiving antibiotics alone (6.3% v 9.9%; p =0.045), however rates of favorable outcomes did not differ (22.5% vs. 25.0%, p=0.343). In sub‐group analysis of ruptured IIA (n=633, 23.4% of total cohort), intervention yielded significantly lower mortality rates (10.6% v 24.8%, p<0.001) and a trend toward increased rates of favorable outcomes (14.3% v 9.1%, p=0.077). In sub‐group analysis of unruptured IIA, intervention resulted in lower absolute mortality rates (2.9% v 6.0%, p=.088) but no difference in favorable outcomes (28.9% v 29.1, p=0.957).

Conclusion

While treatment of IIA often involves a multidisciplinary approach, antibiotics as part of medical management remains integral. Our study showed that intervention in addition to medical management led to decreased mortality rates, especially in patients with ruptured IIA. Further directions for future studies include elucidating predictors of favorable outcomes for undergoing intervention and the most beneficial timing for the procedure during hospitalization.
Abstract 139: Safety and Efficacy of Tirofiban Use in Acute Ischemic Stroke Patients Undergoing Thrombectomy: A Meta‐Analysis
Authors: Naeem A. , Albaramony N. , Ewis A. , Ahmed M. , Kelani H. , Spiotta A.
Published: January 2025

Introduction

Intravenous thrombolysis with tissue plasminogen activator (tPA) and endovascular therapy (ET) represent the cornerstone of modern stroke management. Despite advancements in these therapies, a subset of patients fails to achieve optimal recanalization (TICI 2b‐3), which is associated with poor functional outcomes and higher mortality rates. As a result, there has been growing interest in adjunctive pharmacologic interventions that could enhance the efficacy of ET. The efficacy and safety of tirofiban as an adjunct to ET have not been conclusively established, with existing studies yielding inconsistent results.

Methods

We conducted a systematic review and meta‐analysis to assess the efficacy and safety of tirofiban in patients undergoing thrombectomy. A comprehensive search was carried out across PubMed, Embase, and the Cochrane Library for studies published through August 2024. For each outcome, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was evaluated using the I² statistic. Statistical analyses were performed using R.

Results

The meta‐analysis included 21 studies evaluating the effect of tirofiban plus ET on successful recanalization (TICI 2b‐3), showing a significant benefit with an odds ratio (OR) of 1.41 (95% CI 1.21‐1.65, p < 0.01), with low heterogeneity (I² = 25%). For excellent functional recovery (mRS 0‐1), 14 studies were analyzed, demonstrating a significant improvement with an OR of 1.17 (95% CI 1.03‐1.34, p = 0.02), and moderate heterogeneity (I² = 37%). In assessing good functional recovery (mRS 0‐2), 25 studies were pooled, and showed a significant effect of tirofiban plus ET with an OR of 1.30 (95% CI 1.19‐1.44, p < 0.01), with low heterogeneity (I² = 24%). Mortality outcomes across multiple studies revealed a significant reduction in mortality (OR 0.70, 95% CI 0.59‐0.84, p < 0.01), with moderate heterogeneity (I² = 44%). Lastly, for symptomatic intracranial hemorrhage (sICH), no significant difference was observed (OR 0.88, 95% CI 0.75‐1.04, p = 0.14), and heterogeneity was low (I² = 12%).

Conclusion

In conclusion, the meta‐analysis demonstrates that the addition of tirofiban to Endovascular Therapy (ET) significantly improves successful recanalization and functional recovery (mRS 0‐1 and mRS 0‐2) while reducing mortality, with low to moderate heterogeneity across the included studies. However, no significant difference in the risk of symptomatic intracranial hemorrhage (sICH) was observed. These findings suggest that Tirofiban plus ET may enhance clinical outcomes in patients undergoing treatment for acute ischemic stroke.
Abstract 162: Vertebral Artery Stenting for Compression Stenosis Due to Cervical Facet Hypertrophy
Authors: Fakih R. , Khan M. , Tolba H. , Bhatti I. , Gillani S. , Qureshi A. I.
Published: January 2025

Background

Vertebrobasilar insufficiency can be caused by various pathologic conditions including atherosclerosis, dissections, steal phenomenon, etc. While endovascular treatment of those conditions is well‐established, stenting of vertebral artery (VA) compression stenosis due to cervical facet hypertrophy is uncommon. We describe a case of VA stenting to address the symptomatic stenosis caused by mass effect from cervical facet hypertrophy.

Method

A 78‐year‐old male with a history of deep venous thrombosis and paroxysmal atrial fibrillation presented with several episodes of transient loss of awareness triggered by neck movement from side to side. This has restricted his neck mobility. Computed tomography angiography (CTA) revealed stenosis of the left VA at the C3‐C4 level secondary to cervical facet hypertrophy. Decision was made to treat this problem via endovascular means.

Results

Access was achieved via the right femoral artery, and a guide catheter was parked in the left subclavian artery just proximal to the left VA ostium. The left VA was selected with an intermediate catheter, and angiography revealed a moderate stenosis at the cervical V2 segment, with no evidence of atherosclerosis nor dissection. 3D rotational angiography confirmed the stenosis being caused by a C3‐C4 facet hypertrophy impinging on the artery. We proceeded with angioplasty and stenting at the point of stenosis, using a balloon‐mounted Papyrus stent. Follow‐up angiography showed improvement in the degree of stenosis. At 1‐month follow‐up, patient was symptom‐free, with no recurrence of his symptoms.

Conclusion

This case illustrates vertebral stenting a potential therapeutic option for vertebral artery compression stenosis caused by cervical facet hypertrophy. Although residual stenosis remained, the intervention improved the patient's symptoms.
Abstract 187: Age impact on stroke risk and healing in patients treated with flow diverters for intracranial aneurysms: SCENT substudy
Authors: Wakhloo A. , Jenkins P. , Meyers P. M. , Coon A. L. , Kan P. T. , Puri A. , de Vries J. , Lanzino G. , Bain M. , Ebersole K. C. , Welch B. G. , Dogan A. , Jabbour P. , Mocco J. , Siddiqui A. H. , Turk Q. S. , Taussky P. , Hanel R. A.
Published: January 2025

Introduction/Purpose

The multicenter, prospective, single‐arm, controlled, non‐randomized SCENT trial on flow diverter (FD) treatment for intracranial aneurysms (IA) was analyzed for patients’ age and IA characteristics impacting stroke and occlusion rates over 5 years.

Materials and Methods

Impact on major ipsilateral stroke and IA occlusion was studied by stratifying age as </= 65 years versus >65 years. Twice as many subjects treated were </= 65 years old (n=119/180). Product‐limit (Kaplan‐Meier) estimates of time to both endpoints, stratified by age group, were created. Univariate predictors of time to stroke were identified by including candidate variables in univariable proportional hazards regression models. Those variables found to be significant (p<0.10) at the univariate level were entered into a multivariable survival model to identify independent predictors. The stepwise selection produced a final reduced model with a significance level to both enter and stay set at 0.05.

Results

When parent artery stenosis and IA size were entered into a multiple‐stepwise survival model, only stenosis remained as an independently significant predictor of time to stroke. At 3‐year follow‐up, there were a total of 23 strokes (12.8%), with 11 (47.8%) occurring in subjects </= 65 years; there was a greater risk for seniors (HR1.96, 95% CI 0.83‐4.78, p=.122). Four patients (4/180; 2.2%) experienced aneurysm ruptured within the first week post‐treatment, with 3 being </= 65 and the fourth aged 66 years. No new strokes were reported between 3 and 5 years. Complete IA occlusion rates for seniors were 60.0% (33/55), 67.6% (25/37), and 85.7% (18/21) at 12, 36, and 60 months, respectively, as compared to 79.1% (87/110), 82.5% (66/80), and 91.8% (56/61) for younger subjects. The time to complete IA occlusion was shorter in younger patients (HR1.53, 95% CI 1.07‐2.19, p=.020). Five subjects (2.8%) underwent retreatment, 2 in 60‐year‐old patients, and one each aged 64, 70, and 75.

Conclusion

Stroke, early rupture risk, and aneurysm occlusion in patients treated with FD are related to age and pre‐existing parent artery stenosis, IA size, and location. With demographic shifts, future treatments need to focus on expedited and improved healing.
Abstract 195: Assessing the Safety and Efficacy of Heparin in Ruptured Intracranial Aneurysms
Authors: Kothari S. A. , Baskaran A. , Morsi R. , Desai H. , Smith M. , Kozel O. , Chahine A. , Patel S. , Iourinets J. , Jafary H. , Borghei A. , Lis P. , Prabhakaran S. , Siegler J. , Kass-Hout T.
Published: January 2025

Introduction

Our study aims to retrospectively assess the safety of heparin during endovascular treatment of ruptured intracranial aneurysms.

Methods

A retrospective analysis of 56 patients who underwent endovascular aneurysmal repair for both ruptured and unruptured aneurysms was performed to examine outcomes.

Results

This series included 41 females (73.2%) and 15 males (26.8%) with a mean age of 55.9 ± 15.2 years treated with endovascular embolization of which there were 30 ruptured and 26 unruptured aneurysms. A total of 22 patients received an intraoperative heparin load before the procedure ranging from 3000‐7000 units. Therapeutic‐activated coagulation times were measured and maintained in all patients. Of the ruptured aneurysm cohort that received a heparin load (8/30, 26.7%), there was 1 thromboembolic complication intra‐procedurally, 1 thromboembolic complication post‐procedurally, and 1 hemorrhagic complication post‐procedurally. Of the unruptured aneurysm cohort (14/26, 31%) that received a heparin load, there was 1 thromboembolic intra‐procedurally and 0 hemorrhagic complications post‐procedurally.

Conclusion

This study suggests that heparin during endovascular treatment for ruptured intracranial aneurysms carries similar safety to those untreated with heparin pre‐procedurally warranting larger studies and further investigation.
Abstract 207: Beyond the Hospital: Evaluating the Durability of Outcomes for Stroke Survivors Receiving Principal Illness Navigation Services
Authors: Sheehan L.
Published: January 2025

Introduction/Purpose

Post‐acute navigation services for stroke survivors have started to emerge over the last few years, spurred on by high readmission rates and subpar quality of life in the months after stroke discharge. While there is limited but promising evidence related to the outcomes of these navigation services post‐stroke, there have been few studies that have reviewed the durability of outcomes such as longitudinal readmission rates, quality of life metrics or functional status. This study aims to assess the 6‐months and 1‐year post‐discharge outcomes for stroke patients receiving post‐acute of Principal Illness Navigation (PIN) services. Measures will include inpatient readmission rates, quality of life via the PROMIS Global 10 and the modified Rankin Scale.

Materials/Methods

This is a mixed methods design including the retrospective analysis of readmissions data via historical HIE and ADT feeds along with the assessment of QoL and mRS based on patient report (PROMIS Global and 1 question mRS, respectively). In addition, patient and care partner surveys were conducted at 6‐months and 1‐year to assess ongoing recovery challenges as well as the longitudinal impacts of participation in PIN services after hospital discharge following stroke.

Results

Our abstract will review inpatient readmission rates for patients who reached at least 6 months post‐discharge, and those who reached at least 12 months post‐discharge. We will compare these results to published benchmarks, reporting 12‐month readmission rates ranging from 30% to nearly 50%. We will also report on patient self‐reported health challenges, SDOH concerns, and ability to live independently at 6 and 12 months post‐stroke.

Conclusion

The findings from this study will highlight the potential durability and long‐term benefits of Principal Illness Navigation (PIN) services for stroke survivors, particularly in reducing readmission rates compared to published data. Stroke patients historically experience very high and recurrent readmissions, and persistent challenges related to ambulation, fatigue, mental health, and socioeconomic stressors. Our preliminary results suggest that PIN improves key outcomes and that there is still a need for ongoing, comprehensive support beyond the first year of recovery. Addressing these long‐term needs, particularly mental health, will be critical to further enhancing stroke survivors’ quality of life and functional independence.
Abstract 240: Diagnostic Value of Catheter Angiography and Magnetic Resonance Imaging in Perimesencephalic and Non‐Perimesencephalic Subarachnoid Hemorrhage: A Retrospective Analysis
Authors: Gong A. , Khan H. , Dang D. , Sterner R. , Fortes M. , Greenberg E. , Chandela S. , Chitale A. , Chaudhry S. , Vyas N.
Published: January 2025

Introduction/Purpose

Spontaneous subarachnoid hemorrhage (SAH) without a structural source can be seen in up to 15% of all spontaneous SAH, which includes diffuse non‐aneurysmal SAH, sulcal SAH and perimesencephalic (PM) SAH. Although catheter angiography is considered the gold standard to exclude a vascular etiology, multiple studies suggest that computed tomography angiography (CTA) is adequate in PMSAH and magnetic resonance imaging (MRI) does not produce additional benefit. Without clear recommendations, practice patterns regarding the diagnostic management of these patients remain variable throughout the country. The aim of this study was to evaluate the diagnostic value of MRI and catheter angiography in perimesencephalic (PM) and nonperimesencephalic (non‐PM) subarachnoid hemorrhage (SAH) of unknown origin.

Materials and Methods:

We conducted a retrospective study of all patients with spontaneous SAH between January 2021 and July 2023. Included in the study were cases of spontaneous SAH diagnosed with CT with an initial negative digital subtraction angiogram (DSA). Additionally, patients who had a positive finding for a vascular source of hemorrhage such as an aneurysm, arteriovenous malformation (AVM) or dural arteriovenous fistula (dAVF) on DSA with a negative CTA or a CT with a PMSAH bleeding pattern were included for comparison. The number and types of follow‐up imaging studies were recorded.

Results

420 patients with spontaneous SAH were screened, in which 101 patients met study criteria. 86 patients were found to have a negative DSA, of which 51 (59.3%) were found to have a PMSAH bleeding pattern. Follow‐up MR performed within one week of presentation demonstrated no source of hemorrhage in any of the patients with PMSAH, however, within the subgroup of diffuse‐non‐aneurysmal SAH, two patients (5.7%) were found to have a cavernoma on MRI (p=0.039). Among the 226 patients (53.8%) who had a positive DSA in the same time period, nine patients (3.9%) had a negative CTA and 10 patients (4.4%) had a PMSAH hemorrhage pattern.

Conclusion

In spite of a well‐established hemorrhagic pattern for aneurysmal SAH, aneurysms may still present with a perimesencephalic SAH distribution. In light of our institutional experience, CTA is not deemed adequate alone for the exclusion of aneurysms in PMSAH, where catheter angiography should still be considered the gold standard in diagnostic evaluation. Finally, MRI of the brain and craniocervical region did not produce any benefit for the detection of a vascular etiology in PMSAH, however, the utilization of MRI should be considered for rare bleeding sources in non‐PM SAH, particularly when intraparenchymal hemorrhage is also present.