bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional Annotation of Bipolar Disorder 2 Risk Location Implicates Novel Susceptibility Genes
Authors: Can Güneş Şayan , Bakır Ebru , Oktay Yavuz
Published: January 2025

Introduction: Bipolar 2 disorder (BD2) is an independent disease with specific familial aggregation, significant functional impairment, specific treatment challenges and several distinctive clinical features. However, unlike bipolar 1 disorder, studies investigating causal and functional genes are lacking. This study aims to identify and prioritize causal genetic variants and genes for BD2 by analyzing brain-specific gene expression markers, to improve the understanding of its genetic underpinnings and support advancements in diagnosis, treatment and prognosis.
Method: We used FUMA, a genome wide association study (GWAS) annotation tool, to pinpoint potential causal variants and genes from the largest BD2 GWAS data. Candidate causal variants most likely affecting brain gene expression were prioritized using the following criteria: (1) variants identified as eSNPs in any brain region within any brain expression quantitative trait loci (eQTL) dataset; (2) variants annotated in the Regulome database with a score <5, indicating likely functional localization; (3) the most common 15-core chromatin state across all cell types in the Roadmap Epigenomics data being ≤7, reflecting an open chromatin state; (4) localization in genomic regions with evidence of 3D chromatin interactions, as such interactions mediate genetic effects on gene expression.
Results: We identified AGRN, ORMDL3, SLC25A39, RUNDC3A, NOS2, C1orf159, RP11-5407.18, RP11-465B22.3, RP11-5407.17 as candidate causal genes. These genes are associated with important pathways such as synapse formation, mitochondrial and oxidative metabolism, intracellular transport, neurotransmission and lipid metabolism-related pathways.
Conclusion: This study provides a guide for further experimental validation of functional variants, BD2-associated genes and novel drug targets.
Dossiê Crítica da narrativa seriada (parte 2)
Authors: Serelle Marcio , Soares Rosana de Lima
Published: January 2025

Editorial da edição 36 / número 18
Abstract 004: Early Feasibility Study of RapidPulse® Aspiration System as Frontline Approach for Patients with Acute Ischemic Stroke due to Large Vessel Occlusions (Pulse‐C Study)
Authors: Nogueira R. , Geyik S. , Bajrami A. , Ribo M. , Mernes R.
Published: January 2025

Background and aims

The first‐pass effect (FPE) is associated with improved clinical outcomes in mechanical thrombectomy (MT) for large vessel occlusion strokes (LVOS). However, current devices achieve FPE in only 30‐40% of patients. The RapidPulse® Aspiration System (RP) is designed to remove occlusive thrombus from the cerebral vasculature using precisely pulsed aspiration. The system aims to improve revascularization results during aspiration thrombectomy in patients with acute ischemic stroke. Initial clinical evaluation suggests that RapidPulse® can achieve FPE rates in the 70% range. Our goal is to evaluate this technology as a frontline approach in LVOS.

Methods

Prospective, multicenter, open‐label, early experience study of the RapidPulse® System. Patients with LVOS involving anterior and/or posterior circulations within 24 hours from stroke onset, without evidence of intracranial atherosclerotic disease and/or tandem occlusions, and amenable to treatment with the RapidPulse 071 aspiration catheter were eligible. The primary outcome was the rate of FPE (mTICI ≥2c after one pass). Secondary outcomes included frontline technical success (mTICI ≥2b after final pass with no rescue therapy), and incidence of vessel injury and/or device related SAEs. The study will enroll up to 50 participants at up to 5 centers in Europe and Latin America.

Results

As of August 2024, ten patients have been recruited and enrollment is expected to be completed in November 2024. The results of the study will be presented at the SVIN conference.

Conclusions

The RapidPulse® system is a novel cyclic aspiration technology designed to achieve faster and better reperfusion in LVOS while significantly improving FPE and frontline success rates which, in turn, may improve clinical outcomes and reduce overall procedure costs. Additional larger studies are underway.
Abstract 116: Initial first in man clinical case experience with the novel adaptive tip Hippo ‐ Cheetah Aspiration system: a review of 58 AIS cases
Authors: Chaudry I. , Vargs J. , Turk A. , Tuner R.
Published: January 2025

Objective

The Q'Apel Medical Hippo aspiration system is a novel, adaptive tip catheter system that is capable of passively adapting its tip shape to conform to the thrombus. It includes a Cheetah delivery insert to aid in tracking to the intracranial circulation. We performed the first‐in‐human cases with the Hippo and present our initial experience.

Methods

A single center retrospective review of prospectively collected data from consecutive patients who underwent mechanical thrombectomy for anterior circulation LVO is presented from October 1, 2023 (Hippo US approval) to Februraury 28, 2024. All clinical data was prospectively captured by the Stroke Neurology team. Angiography data was adjudicated by two of the authors. All follow up imaging at 24 hrs was reported by Neuroradiology.

Results

45 Anterior Circulation4 Posterior circulation6 ICAD cases3 other cases58 total cases 58 total Hippo AIS cases were identified from 10/1/2023 to 2/28/2024. Of these, 3 cases included a cervical ICA occlusion, bilateral MCA occlusion and one case where guide catheter access could not be achieved and the procedure terminated, 6 cases of underlying ICAD where Hippo was used in combination for aspiration and/or as a conduit to deliver adjunctive devices, 4 posterior circulation LVO aspiration cases and 45 AIS Anterior circulation LVO procedures.

Of the 45 Anterior circulation LVO cases; 16 (36%) of patients receive TNK. Mean presenting NIHSS was 18.9 and mean discharge NIHSS was 7.5. Mean time of onset to groin puncture was 276 mins, mean time to recanalization was 31 mins. 6 patients had tandem occlusions.

First pass TICI □ 2C rate was 22/45 (49%), Final TICI □ 2B: 40/45 (89%), TICI □ 2C: 36/40 (80%), TICI 3 29/45 (64%). 33/45 (73%) were performed with BGC (Walrus).

5 cases required bailout stent‐retriever. In two cases an additional 070 aspiration catheter was used and in total 14 cases required an adjunct aspiration catheter.

A 90 day mRS of 0‐2 was achieved in 21/45 (47%), 4 patients were lost to follow up, 1 patient has not reached a 90 day end point. 14 patients had evidence of hemorrhage vs contrast staining on 24 hr imaging, 1 classified as PH2. There was one SAH, from a vessel perforation, likely catheter related 1/45 (2%).

Hippo was able to achieve its target location in all but two cases. In one case multiple devices were attempted, finally a velocity microcatheter was used to deliver a stent retriever. In the second case, supraclinoid stenosis prevented Hippo from accessing the M1 and it was used to deliver a RED 43 to the target lesion.

Conclusion

Our initial experience with the Hippo Aspiration system demonstrates it to be safe and efficacious with high rates of reperfusion, low complications and low use of adjunctive catheters. A synergistic effect with BGCs maybe present. Further studies are warranted.
Abstract 140: Safety and Efficacy of Trans carotid Intervention in Multiple Scenarios: Medellin Experience using Direct Carotid access
Authors: Mutis J. , Pabon B. , Torres V. , Vergara J. , Brunet F. , Pelaez F. , Patino M. , Cardozo M. , Arteaga J. , Vargas G.
Published: January 2025

Purpose

Direct Carotid Puncture (DCP) has been validated such as an alternative route to reach the intracranial vasculature. However, this approach has not been considered routinely in INR.This study was conducted to investigate the feasibility and safety of trans carotid Neuro intervention for a variety of pathologies.

Materials and methods

Since 2018 we implemented a DCP under special considerations to perform a therapeutic approach. A total of 28 patients from our centers were analyzed. Patients were divided into a variety of neurovascular conditions: Carotid Stenting CAS (n = 4), Mechanical Thrombectomy MT (n=10), AVM´s treatment (n=4), intracranial Aneurysms treatment (n=10). Patient demographics, technical data, intervention time, type of intervention, closure device used, local or systemic complications and a patient perception assessment were registered.

Results

Mean age was 64.3 ± 10.3 years. in all cases but two were treated under GA. Major indication to this approach were: anatomical and access limitations in 24 cases and, two patients with Leriche Syndrome. All cases performed with ultrasound US assistance. A 4 Fr. Micro‐ puncture set were used in all procedures and posteriorly a 6Fr. Introducer was inserted. Technical success in all cases (100%) selected. Two patients presented mild vasospasm and resolved using IA vasodilators. All CAS were performed without any complications and none embolic protection device used. For MT(n=10): a SOFIA 6Fr for ADAPT was used in 6 cases with TICI 2b‐3 in all cases. Combined approach was used in four cases, one TICI 2a and one TICI 3. A total of 10 aneurysms were treated with this approach (4 ICA – ophthalmic; 4 MCA and two AcomA) Mean average time of the procedure was 34.5 min. (ranged 9‐59 min) Only one hemorrhagic complication observed at the closure device use. In all cases but one we use Angio‐Seal 6Fr as closure device, in a single case where we used a ProGlide suture device we had a serious complication at the puncture site.

Conclusion

Trans Carotid Intervention TCI. was feasible and safe in selected patients in this small series. A multiple variety of neurovascular conditions would be treated successfully by this way improving the learning curve. Complication rates and clinical outcomes were comparable with those in trans femoral or radial approach.
Abstract 164: Discontinuation and Non‐Publication of Stroke Clinical Studies: A Cross‐Sectional Analysis
Authors: Aljabali A. , Alkhawaldeh I. M. , Abdelhady M. , Hamza A. I. , Ababneh A. , qudah k. , Al‐Amour A. , Shanaah M. , Abualhayjaa M. , Awad H. , Negida A.
Published: January 2025

Background

Stroke is the second leading cause of both disability and death worldwide, with the highest burden of the disease shared by low‐ and middle‐income countries. In 2022, there are over 101 million people currently living who have experienced stroke globally. Clinical studies in stroke are vulnerable to discontinuation and non‐publication, representing significant sources of research waste in clinical medicine. This study aims to assess stroke clinical studies characteristics and summarize logistic, financial, and practical reasons behind early discontinuation and non‐publications to prevent this in the future.

Methods

ClinicalTrials.gov
was searched for all studies registered between 1 January 2000 and 1 May 2022 and included patients with stroke. Publications from these studies were identified by extensive online searching using the NCT identifier number and other related keywords. Multiple logistic regression analysis was performed to identify characteristics associated with trial discontinuation and non‐publication.

Results

A total of 3720 eligible registered studies were included; 2724 (73.3%) were clinical trials, and 994 (26.7%) were observational studies. Of these, 380 (10.2%) were discontinued. Of the completed studies, there were a total of 1786 (53.5%) non‐published studies. The unadjusted logistic regression analysis revealed that the industrial (OR = 1.37, 95% CI [1.05‐1.79]) and mixed funding (OR = 1.42, 95% CI [1.04‐1.92]) were significant predictors of study discontinuation compared to non‐industrial funding. Furthermore, the small sample size (less than 100) (OR = 2.79, 95% CI [2.13‐3.66]) was also significant. Concerning the non‐publication, a small sample size (less than 100) (OR = 1.68, 95% CI [1.46‐1.93]) was also a significant predictor, while mixed funding (OR = 0,56, 95% CI [0.45‐0.70]) compared to non‐industrial funding has significantly decreased the likelihood of non‐publication. Behavioral interventions were significantly less likely to be discontinued than drug interventions (OR = 0,40, 95% CI [0.27‐0.60]). The Diagnostic interventions were significantly the most likely to be non‐published compared to drug interventions (OR = 3.39, 95% CI [1.85‐6.21]).

Conclusion

There is evidence of non‐dissemination bias in clinical studies of stroke. These biases distort the therapeutic information available to inform clinical practice and raise ethical concerns regarding exposing volunteering participants to potential risks without furthering practice.
Abstract 185: Advancing Acute Ischemic Stroke Treatment: Utilizing Flexible Balloon Guide Catheters via Radial Artery for Thrombectomy
Authors: Radhi H.
Published: January 2025

Introduction

Acute ischemic stroke is a critical condition requiring prompt and effective intervention. The radial artery approach for endovascular thrombectomy has emerged as a promising alternative to the traditional femoral access, offering several procedural benefits. This abstract summarizes our clinical experiences and observations using balloon guide catheters (BGCs) in treating ischemic stroke through the radial artery.

Methods

Our experience is based on a series of ischemic stroke patients treated with thrombectomy via the radial artery approach using BGCs. We documented procedural details, patient comfort, recanalization success, and any encountered complications. Our primary focus was on the practicality, efficacy, and safety of this method.

Results

In our series, we observed that the use of BGCs facilitated effective and rapid clot retrieval, with successful recanalization rates akin to those reported in larger studies (achieving Thrombolysis in Cerebral Infarction [TICI] scores of 2b/3 in the majority of cases). Procedural times were generally efficient, and patients exhibited a notable reduction in procedural discomfort and post‐operative complications compared to traditional femoral access. Observed complications were minimal and typically manageable, further underscoring the viability of this approach.

Conclusion

Based on our clinical experience, the use of balloon guide catheters in thrombectomy procedures via the radial artery presents a viable and effective alternative to femoral access. This approach not only maintains high success rates in vessel recanalization but also enhances patient comfort and reduces complications. These positive outcomes suggest that radial artery access with BGCs deserves further consideration and wider application in the treatment of acute ischemic stroke.
Abstract 198: Association of GLP‐1 Receptor Agonist Use with Clinical Outcomes in Diabetic Patients Hospitalized for Ischemic Stroke
Authors: Iourinets J. , Viswanath V. , Jhaveri A. , Chahine A. , Sehgal N. , Morsi R. Z. , Goicoechea E. Badillo , Thind S. , Desai H. , Kothari S. A. , Siegler J. E. , Coleman E. R. , Brorson J. R. , Prabhakaran S. , Mansour A. , Kass‐Hout T.
Published: January 2025

Background and Purpose

Glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) have shown cardiovascular benefits in patients with type 2 diabetes mellitus (T2DM). Given the risk factor overlap between neurovascular and cardiovascular disorders, we aimed to evaluate the association of GLP‐1RA use with clinical outcomes in diabetic patients admitted for acute ischemic stroke (AIS).

Methods

This single‐center retrospective study included diabetic patients aged ≥18 years admitted for AIS from 2015‐2023. GLP‐1RA use was defined as a history of taking GLP‐1RA at admission or being prescribed GLP‐1RA at discharge. The primary outcome was the incidence of new ischemic stroke within 1 year. Secondary outcomes included functional independence (modified Rankin Scale score 0‐2) and mortality at 90 days. Propensity score weighting was used to balance covariates between groups. Logistic regression was used to estimate log odds ratios (LORs) for outcomes.

Results

Of 123 patients, 35 (28%) used GLP‐1RA. The GLP‐1RA group had lower incidence of new ischemic stroke at 1 year (2.9% vs 6.8%; adjusted LOR ‐1.13, 95% CI ‐3.21‐0.95, p=0.28) and higher rates of functional independence at 90 days (67% vs 40%; adjusted LOR 2.38, 95% CI ‐0.12‐4.87, p=0.06) compared to the non‐GLP‐1RA group, but these differences were not statistically significant. Mortality at 90 days was similar between groups (25% vs 26%; adjusted LOR 0.078, 95% CI ‐1.51‐1.67, p=0.92).

Conclusions

In this cohort of diabetic patients admitted for AIS, GLP‐1RA use showed a trend toward reduced incidence of recurrent stroke and improved functional outcomes, although not statistically significant. Larger prospective studies are needed to further evaluate the potential neuroprotective effects of GLP‐1RAs in ischemic stroke.
Abstract 230: Comparison of clinical outcomes and complications in patients undergoing Carotid Artery Stenting (CAS) with or without pre and poststent balloon angioplasty.
Authors: Martucci M. , Ezzeldin M. , Delora A. , Hassan A. , Siddiq F. , Sheriff F. , Kan P. , Janjua N. , Asif K. , Grandhi R. , Alaraj A. , Niazi M. , Mansour O. , Chen M. , Bushnaq S. , Tanweer O. , Navpreet B. , Miller S. , Colina G. , Rodriguez G. , Maud A. , AlMajali M. , Barakat B. , Edhayan G. , Froukh M. , Salah W. , Nico E. , Ashraf S. , Radiaideh Y. , Quispe‐Orozco D. , Zaidat O. , Hussain M.
Published: January 2025

Background and Objective

Carotid artery stenting (CAS) is a procedure that has been established as a safe and effective alternative to carotid endarterectomy in high surgical risk patients. There are procedural questions that remain unanswered, specifically, the safety of pre‐stent balloon angioplasty versus post‐stent versus both. The objective of our study is to understand the risk and safety of these procedural techniques.

Methods

Multicenter retrospective data related to angioplasty balloons, stents, complications due to pre and post‐stent angioplasty along with the modified Rankin score (mRS) before and after the procedure were collected from January of 2015 until December of 2022. Statistical analysis was performed to correlate this data with risks of complications and clinical outcomes.

Results

A total of 1355 patients were enrolled. We found that patients who underwent pre‐stent angioplasty, or both (pre and post‐stent angioplasty) had a higher risk of complications compared to those who only had post‐stent angioplasty. There were more complications in patients who did not undergo post‐stent angioplasty as compared to those who did undergo angioplasty (p=0.018, OR=0.513). Follow‐up MRS at 30‐90 days was higher if the balloons in both pre‐stent angioplasty (p=0.016) and post‐stent angioplasty (p=0.020) stent angioplasty were not inflated to nominal pressure. Follow up MRS was statistically higher (p=0.01) in patients with open‐cell stents than closed‐cell stents. Open‐cell stents were more likely to undergo post‐stent angioplasty (p<0.001) while closed‐cell stents were more likely to undergo pre‐stent angioplasty (p=0.002).

Conclusions

Patients who underwent post‐stent angioplasty alone had less risks of complications compared to pre‐stent angioplasty or combination. This is contrary to prior studies published on this subject and could be related to improvement in technique and in technology in recent years. There is a higher rate of post‐stent angioplasty in patient who received open cell stents, but these also had higher mRS at 30‐90 days compared to closed cell stents.
Abstract 234: Current Stroke Solutions Using Artificial Intelligence: A Review of the Literature
Authors: Elrefaei A. , Al‐Janabi O. M. , Bakir D. , Mahmood Y. M. , Elgazzar T. , Gajjar A. , Alateya A. , Jha S. K. , Ghozy S. , Kallmes D. F. , Brinjikji W.
Published: January 2025

Introduction

Recently, artificial intelligence (AI) has emerged as a tool for improving stroke diagnosis, enhancing critical decision‐making, and improving acute ischemic stroke (AIS) care. AI‐based platforms such as RapidAI, Brainomix® and Viz.ai, amongst others, have been studied to improve image analysis, detect large vessel occlusions (LVO), and predict patient outcomes in a timely manner. However, there is limited data pertaining to the impact of these AI platforms on real‐world patient care and management. The objective of this literature review is to evaluate the effectiveness and accuracy of AI platforms in facilitating the treatment of AIS.

Methods

Following the PRISMA guidelines, a comprehensive systematic review was conducted using PubMed, Embase, Web of Science, and Scopus databases. Studies that meet the inclusion criteria were included. The final selection comprised studies that provided detailed analyses of AI tools, focusing on their sensitivity, specificity, accuracy, and comparative effectiveness.

Results

A total of 31 studies were included of which 29 studies primarily focused on detecting AIS or LVO, and 2 studies explored the use of AI in hemorrhagic strokes. AI tools including Viz.ai, RapidAI, and Brainomix®, demonstrated great utility in stroke management. These tools contributed to significant reductions in door‐to‐puncture times, enhanced accuracy in estimating core and penumbra volumes, and provided reliable assessments of ASPECT scores and the presence of intracranial hemorrhage. RapidAI was noted for its ability to rapidly identify LVOs. Viz.ai showed high accuracy in detecting both AIS and LVO, with sensitivity and specificity comparable to expert human interpretation. Brainomix® offered advantages in evaluating stroke severity and predicting outcomes, thereby aiding in the decision‐making process for intravenous thrombolysis and endovascular thrombectomy.

Conclusion

Integrating AI tools in stroke care proves to be a valuable tool for aid diagnostic and management measures for greater accuracy and faster decision‐making, leading to improved patient outcomes. Considering the advancement in technology, AI‐based platforms are escalating to become vital assets for personalized care, providing a new level of hand‐tailored and expedited stroke management in the near future.
Abstract 258: Efficacy and Safety of Trans‐radial Versus Trans‐femoral Access for Mechanical Thrombectomy in Acute Ischemic Stroke
Authors: Rehman M. Aemaz ur , Rehman M. U. , Rehman A. U. , Ali H. , Rahman M. U. , Ghozy S. , Tariq M. , Kallmes D. F.
Published: January 2025

Introduction

Mechanical thrombectomy for ischemic stroke has traditionally been performed via transfemoral access (TFA). However, newer literature on the subject suggests that trans‐radial access (TRA) may be equally efficacious.

Materials and Methods

Using relevant keywords, online databases (including Pubmed, Google Scholar, Embase, and Cochrane) were queried from inception until May 2024. Abstracts and full texts were screened according to Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines to shortlist studies that met the inclusion criteria. Risk of bias assessment was performed according to the New Castle Ottawa Scale and Cochrane risk of bias tool 2.0. All dichotomous outcomes were reported as odds ratio (OR) with 95% confidence interval (CI). RevMan software was used to perform the statistical analysis.

Results

Thirteen observational studies and one randomized clinical trial were included in this meta‐analysis. The total sample size was 4973, of which 4074 patients (81.2%) were included in the TFA group and 899 (18.8%) were included in the TRA group. No significant differences were observed between the two groups in terms of successful recanalization (OR=0.92; 95% CI 0.66‐1.27;
p
=0.60), first‐pass recanalization (OR=0.84; 95% CI 0.69‐1.01,
p
=0.06), access to reperfusion time (mean difference ‐2.99 minutes; 95% CI ‐8.33 to 2.44,
p
=0.27) and favorable functional outcome. Mortality and rates of intracranial hemorrhage were comparable between the two groups as well, but access site complications were significantly lower in the TRA group (OR=0.57; 95% CI 0.37‐0.88;
p
=0.01).

Conclusion

Trans‐radial access for thrombectomy in large vessel acute ischemic strokes is comparable to trans‐femoral access in terms of efficacy and has a lower incidence of access site complications. Randomized clinical trial data on head‐to‐head comparison of two techniques is limited, underscoring the importance of conducting pragmatic clinical trials.
Abstract 276: Evaluating the Frequency of Prestroke Cognitive Impairment Among Stroke Patients: Neurological and Functional Correlates
Authors: Elsayed M. M. , Khabiry H. , Mohamed Y. , Swelam K. , Ramdan S.
Published: January 2025

Introduction

Prestroke cognitive impairment is a critical factor that can significantly impact stroke recovery, yet it is often underrecognized. This study aims to quantify the frequency of prestroke cognitive impairment among stroke patients and to explore its neurological and functional correlates.

Methods

We conducted a comprehensive assessment of 520 stroke patients, employing the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) to diagnose cognitive impairment prior to stroke. Neurological evaluations included the assessment of neuropsychiatric symptoms using the Neuropsychiatric Inventory Questionnaire (NPI‐Q), while functional abilities were measured through Activities of Daily Living (ADL) scales. Additionally, neuroimaging analyses were performed to identify structural brain abnormalities.

Results

Our study found that 32.5% of stroke patients exhibited cognitive impairment prior to their stroke. This impairment was strongly associated with more severe neuropsychiatric symptoms, as evidenced by higher NPI‐Q scores (5.5 ± 4.9 vs. 1.7 ± 2.3, p < 0.001), and greater functional limitations, reflected in ADL scores (1.8 ± 1.9 vs. 0.3 ± 0.8, p < 0.001). Regression analyses further identified older age, the presence of white matter lesions, and medial temporal lobe abnormalities as significant neurological correlates of cognitive impairment.

Conclusion

The study highlights a substantial prevalence of prestroke cognitive impairment in stroke patients and its strong association with both neuropsychiatric symptoms and functional limitations. These findings underscore the importance of early and proactive cognitive assessments in stroke populations. By identifying cognitive impairment before a stroke, healthcare providers can tailor rehabilitation strategies more effectively, potentially leading to improved outcomes for stroke survivors. Integrating routine cognitive evaluations into stroke care protocols may enhance patient recovery and overall quality of life.
Abstract 294: Impact Of COVID‐19 Pandemic On Incidence And Outcome Of Cerebral Venous Sinus Thrombosis: A Nationwide Analysis
Authors: Reddi P. , Mehta A. , Hardigan T. , Kellner C. , Fifi J. , Mocco J. , Majidi S.
Published: January 2025

Introduction

Coagulation pathway activation linked to COVID‐19 predisposes patients to thromboembolic events. The association between cerebral venous sinus thrombosis (CVST) and COVID‐19 has been reported in small retrospective studies and case reports and series.ObjectivesTo examine the incidence of CVST before and during COVID‐19 pandemic and to analyze patients’ demographics and clinical outcome using a nationally representative database.

Methods

The Nationwide Inpatient Sample (NIS) 2018‐2021 databases were queried for CVST patients. Patients were stratified into cohorts based on COVID‐19 as a primary diagnosis. Demographics, comorbidities, rate of stroke and National Institutes of Health Stroke Scale (NIHSS) score were compared between the two groups. Primary outcomes were in‐hospital mortality, and the rate of favorable hospital outcome defined as discharge to home or acute rehab center. Propensity score matching was used for multivariable analyses. Poisson regression analysis was used to analyze CVST trends between pre‐pandemic (2018‐2019) and pandemic (2020‐2021) time periods.

Results

Of 37,635 patients with CVST, 385 had COVID‐19 as a primary diagnosis. A higher proportion of patients with COVID‐19 were Black (24.3% vs 16.0%) and Hispanic (20.3% vs 12.3%). The COVID‐19 cohort had a higher mean Elixhauser Comorbidity Score (11.03 vs 8.63, p=0.03) and higher baseline NIHSS score (15.91 vs 6.38, p=0.001). The COVID‐19 group experienced higher rates of in‐hospital mortality (13.0% vs 5.7%, p=0.007) and longer mean length of stay (12.58 vs 8.11 days, p=0.008). A lower proportion of patients had favorable hospital outcome in the COVID‐19 cohort (45.5% vs 57.7%, p=0.031). However, primary outcomes were comparable in adjusted, propensity matched multivariable analyses. Trend analysis showed a significant increase in CVST rates each year from 2018‐2021, with the greatest increase (33%, p<0.001) occurring during the pandemic between 2020 and 2021.

Conclusions

CVST rates increased during the COVID‐19 pandemic. COVID‐19 related CVST disproportionately affected Black and Hispanic patients and trended towards worse hospital outcomes.
Abstract 317: Isolated Sixth Cranial Nerve Palsy as a Rare Manifestation of Iatrogenic Intracranial Hypotension: A Case Report
Authors: Idris A. , Iqbal Z. , Albanna A. , Eltahir M.
Published: January 2025

Introduction/Purpose

Iatrogenic intracranial hypotension (IH) is an uncommon complication that arises due to cerebrospinal fluid (CSF) leakage, often following spinal procedures or surgeries. The most common presentation is orthostatic headache. In this case, we describe a rare presentation of IH with sixth cranial nerve palsy.

Materials and Methods:

A 32‐year‐old female with a past medical history of heterozygous MTHFR gene mutation and seven first‐term spontaneous abortions presented with one‐day history of double vision. One week before the presentation, she had undergone a caesarean section with epidural anesthesia. On the second day after the procedure, she started to experience holocranial headache with a positional component, improving with lying down and worsening upon standing. Five days later, she started to experience double vision. The diplopia was worst on left gaze. It was horizontal, constant, and worse with distance. Physical examination revealed left sixth cranial nerve palsy with esotropia, while the rest of the examination was unremarkable. Ophthalmologic evaluation showed sharp optic discs without vessel obscuration. Laboratory workup was insignificant. Imaging studies included a CT head showing slight prominence of the pituitary gland, a normal CT venogram, and an MRI brain that revealed diffuse dural thickening and enhancement, narrowing of the mamillopontine distance, and distention of the dural venous sinuses—findings consistent with intracranial hypotension. The patient was treated with an epidural blood patch on the day of presentation. Following the blood patch, the patient experienced significant improvement in her headache the next day, though she continued to experience double vision. She was discharged with follow‐up with neurology clinic.

Results

N/A

Conclusion

This case highlights the possibility of isolated sixth cranial nerve palsy as a manifestation of intracranial hypotension, likely due to nerve traction secondary to low CSF pressure. It highlights the importance of considering intracranial hypotension as a differential diagnosis in patients presenting with headache and sixth cranial nerve palsy, as it challenges the common association with intracranial hypertension and changes the management.
Abstract 327: Mentorship Program for Young Neurologists, Medical Students and Researcher: Lessons from COVID‐19 Lockdown
Authors: Elsayed M. M. , Saleh N. , Elsayed M. , Elsayed A. , Ali M.
Published: January 2025

Introduction

COVID‐19 pandemic has caused unprecedented public health and economicchallenges. Current public health, scientific and research communities are faced by thenecessity to provide a fundamental contribution to tackle the crisis. During the past couple ofyears, we have witnessed an impressive number of initiatives to encourage networkingopportunities, to foster virtual interactions between the different stakeholders involved (healthcare, industry, governments, academics, and patients), and to develop innovative strategies andcollaborative infrastructures in support of clinical care, scientific research, and medicaleducation. In this study, we propose and adopt a novel open and collaborative approach to joinforces from around the world social media websites as an essential tool in the fight against theCOVID‐19 crisis. We also investigated the involvement of crowds as innovation partners can beof great support in medical education.To propose novel virtual mentorship program as a teaching tool to improve career skills amongyoung Neurosurgeon and Ophthalmologists.

Methods

Virtual training program was designed and crowdsourcing was used using socialmedia. Highly qualified senior physicians were paired with junior trainees/students throughonline workshops. Juniors were guided through online platforms and interactive sessions onclinical, research, interviewing, and CV writing skills

Results

Program received an initial wave of 965 applicants from 18 countries. Total of 719participants were provided a generic teaching program, while 246 were enrolled to a morepersonalized program where they received at least 20 sessions from their assigned mentors. Allparticipants had significantly improved their set of skills as evidenced by their community work,clinical skills, and research output.

Conclusion

Online virtual training programs can help great skills transfer between skilledacademic young neurosurgeon, ophthalmologists and young trainees worldwide.
Abstract 332: Multi‐Center Comparison of Safety and Efficacy of Intravenous Thrombolytics in Patients Undergoing Endovascular Therapy: Regression Discontinuity Analysis
Authors: Ali A. , Bauknight M. , Iyyangar A. , Azeem H. , Ballekere A. , Le M. , Bajaj R. , Lee E. , Sheth S. A.
Published: January 2025

Introduction

Many clinical practices have switched from alteplase (tPA) to tenecteplase (TNK) given recent clinical trial results. The safety and efficacy of TNK in endovascular treated cohorts, compared to tPA and no thrombolytic remain incompletely characterized.

Methods

From our prospectively collected multi‐center institutional registry, we identified patients treated with endovascular therapy with and without thrombolysis. All 4 hospitals in the cohort switched from tPA to TNK on a single day (March 7 2023), and patients were included if they were treated within 300 days before or after this date. The primary outcome was likelihood of functional independence (mRS 0‐2) at 90 days. Secondary endpoints included rates of intracranial hemorrhage and substantial reperfusion (TICI 2c‐3). Analysis was performed using sharp regression discontinuity, taking advantage of the fact that switch from tPA to TNK occurred at a specific time, such that other measured and unmeasured confounders should be matched.

Results

Among 161 patients that met inclusion criteria, median age was 69 [IQR 57 ‐ 78], median NIHSS 17 [IQR 11 ‐ 22] and 50% were female. 100 (62%) of patients did not receive thrombolysis, 37 (23%) tPA and 24 (15%) TNK. In univariable analysis, rates of substantial reperfusion were comparable (71% vs. 73% vs. 71%, no thrombolysis vs. tPA vs. TNK, p=0.9), as were rates of hemorrhagic transformation (38% vs. 30% vs. 29%, no thrombolysis vs. tPA vs. TNK, p=0.85). Rates of functional independence were similar (27% vs. 43% vs. 33%, no treatment vs. tPA vs. TNK, p=0.19). In regression discontinuity analysis, restricted to only the patients who were treated with tPA or TNK, there were no differences in likelihood of functional independence (coef = ‐0.96, p=0.83).

Conclusion

In this multi‐center cohort of patients treated with EVT, we did not identify any differences in rates of reperfusion, hemorrhage or functional independence after switching from tPA to TNK.
Abstract 376: Prestroke Cognitive Impairment: Investigating the Role of Premorbid Neuropsychiatric Symptoms and Functional Limitations in Stroke Outcomes
Authors: Elsayed M. M. , Elsayed A. M. , Ramadan D. , Elsayed M. M. , Hussein M. , Alnahdi M.
Published: January 2025

Introduction

Prestroke cognitive impairment plays a critical role in influencing treatment outcomes and recovery in stroke patients. This study explores the relationship between prestroke cognitive status, neuropsychiatric symptoms, and functional limitations, aiming to inform more tailored interventions.

Methods

We conducted a cross‐sectional analysis of 520 stroke patients hospitalized in a neurology unit. The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) was used to assess cognitive status prior to stroke onset. Neuropsychiatric symptoms were measured using the Neuropsychiatric Inventory Questionnaire (NPI‐Q), and functional abilities were evaluated through Activities of Daily Living (ADL) and the Clinical Dementia Rating (CDR) scale.

Results

Our findings revealed that 32.5% of patients exhibited cognitive impairment before experiencing a stroke. This cognitive decline was significantly associated with an increase in neuropsychiatric symptoms (NPI‐Q score: 5.5 ± 4.9 vs. 1.7 ± 2.3, p < 0.001) and greater functional limitations (ADL score: 1.8 ± 1.9 vs. 0.3 ± 0.8, p < 0.001). Further analysis through logistic regression identified older age, the presence of white matter lesions (OR: 1.26, 95% CI: 1.003‐1.58), and medial temporal lobe atrophy (OR: 3.97, 95% CI: 1.62‐9.73) as significant predictors of cognitive impairment.

Conclusion

The study underscores the prevalence of cognitive impairment before a stroke and its substantial impact on neuropsychiatric and functional outcomes post‐stroke. These findings highlight the necessity of early cognitive evaluations in stroke care, suggesting that addressing cognitive decline prior to a stroke could improve patient outcomes through more personalized and timely interventions.
Abstract 411: Starting anticoagulation within 24 hours of primary Middle Meningeal artery embolization for chronic subdural hematoma (SDH) is safe and allows for chronic SDH resorption.
Authors: Zacharatos H. , Snyder T. , Jankowitz B.
Published: January 2025

Introduction

Middle Meningeal artery (MMA) embolization has emerged as an effective treatment for the resorption of chronic subdural hematoma (cSDH), by occluding the blood supply to the subdural hematoma membrane; thereby preventing leakage of blood into the subdural space. Limited data is available for initiating anticoagulation within 24 hours post primary MMA embolization and maintaining the anticoagulation treatment, with regards to its effect on the cSDH.

Methods

A prospective collection of patients requiring MMA embolization for cSDH was maintained from a single center between 2019 and 2023. Patients that received full strength anticoagulation within 24 hours of primary MMA embolization were included in this study. All patients were treated with 100‐300 micron embospheres for distal penetration. Some patients received ONYX embolization at the proximal portion of the Middle Meningeal artery. Alternatively, some patients had the proximal portion of the MMA occluded using coils. A successful outcome is defined as complete resolution of the subdural hematoma and/or trace residual (less than or equal to 4 mm) between 1 and 6 months post treatment, while maintaining medication compliance to the anticoagulation treatment. Subdural hematoma expansion, need for surgical treatment (burr hole and/or craniotomy) and mortality were documented.

Results

39 out of 148 patients (26%) were treated with primary MMA embolization (25 male). Anticoagulation was required for atrial fibrillation (36 patients) and DVT/PE (3 patients). All patients that followed up in clinic confirmed anticoagulation medication compliance. Complete subdural hematoma resolution was seen in 17 (43.5%) patients (mean age 74). 7 patients (18%) demonstrated trace residual (less than or equal to 4 mm) subdural hematoma on the three month follow up CT scan, but they all did not have a six month follow up CT scan. Burr hole evacuation was required in 1 patient (2.5%) due to hematoma expansion. There were no patient deaths or neurologic deficits related to subdural hematoma expansion on anticoagulation following embolization. Following the initial embolization, 8 patients (22%) demonstrated reduced/stable subdural hematoma on their approximate one month follow up imaging, but they had incomplete follow up imaging. Following the initial embolization, 6 patients (15%) have no follow up imaging. The COVID pandemic created an environment that limited access to the hospital for many patients.

Conclusion

Initiation of anticoagulation within 24 hours of primary MMA embolization is safe and can lead to complete resorption of the chronic subdural hematoma. Further studies are required to identify patient characteristics that may lead to hematoma expansion following embolization and the initiation of anticoagulation.
Abstract 419: The Contribution of Neutrophil Extracellular Traps to Coagulopathy in Patients with COVID‐19 Related Vascular Thrombosis
Authors: Couture L. , Baskin L. , Cahuiche A. E. , Enochs C. , Colpo G. Delevati , Nimjee S. , McCullough L. D.
Published: January 2025

Introduction

Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and has been associated with hypercoagulability and an increased incidence of thrombotic events as compared to other viral respiratory infections. In this study, we investigated the levels of neutrophil extracellular trap (NET) biomarkers and von Willebrand factor (VWF) to assess if these could be used to predict the occurrence of a thrombotic event in COVID‐19 patients.

Methods

We enrolled 202 patients hospitalized with symptomatic COVID‐19 infections. Of those, 104 patients did not experience any type of thrombotic events at any time preceding or during their hospitalization. These patients were compared to the other cohort of 98, who experienced thrombotic events before or during their hospitalization. 61 of the thrombotic event patients had the event after initial blood collection, so the predictive capacity of biomarkers in these patients was evaluated.

Results

We found that citrullinated histone H3 (ciH3) was the best predictive biomarker for thrombotic events in COVID‐19 regardless of age, sex, and race. We also found that disease severity was a significant predictor of occurrence of thrombotic event in most groups, including sex, race, and age. Thrombotic events are associated with a higher risk of mortality, specifically in COVID‐19 infection compared to other illnesses. Interestingly, in the age group less than 60, citH3 and neutrophil count were found to be significant predictors of thrombotic event occurrence but was not a significant predictor in the age group above 60.

Conclusion

Our findings of predictive capacity of citH3 and neutrophil count in patients younger than 60 could indicate newfound screening biomarkers for patients in this population. NETs may be involved in the thrombotic complications of COVID‐19, and these thrombotic events contribute to multi‐system organ failure and mortality in COVID‐19. These results may better inform treatment and prophylaxis of thrombotic events, with an emphasis in COVID‐19 and similar viral illnesses in the future to improve outcomes and reduce mortality. Understanding the biological etiologies of this disease and its thrombotic complications can improve therapeutic interventions to reduce the burden of thrombosis in patients with COVID‐19. These results may also be relevant to other infections and may inform potential mechanisms for treatment development for other respiratory diseases with thrombotic complications as well as thrombotic diseases such as Myocardial Infarctions and Ischemic stroke.
Abstract 424: The Impact of RapidAI on Thrombectomy Notification Times in a Large, Multi‐Site, Telestroke System
Authors: Sambursky J. , Avila A. , Boyd C. , Gao L. , McCoy M. , Mayer L. , Devlin T. , Sevilis T.
Published: January 2025

Background

Mechanical thrombectomy is considered the gold standard for treatment of large vessel occlusion (LVO) stroke. Early identification leads to faster puncture times as communication with the team is key. The integration of artificial intelligence (AI) platforms into acute stroke evaluation protocols may lead to more rapid and accurate detection of LVOs resulting in earlier notification of the neurointerventional (NIR) team, as was demonstrated in the VALIDATE study. In this study, we will evaluate if these findings can be generalized to other platforms such as RapidAI®.

Methods

Acute stroke consultations seen in the emergency department in 103 facilities (35 RapidAI® and 68 non‐AI) in 24 states from July 1, 2021 to December 31, 2021 were extracted from the TeleCare by TeleSpecialistsTM database. The encounters were reviewed for LVO, arrival‐to‐NIR notification time (ATN), and whether RapidAI® software was utilized. Patients were classified into two groups based on use of RapidAI® or no AI software. Then subcategorized further based on if they were seen at a thrombectomy capable center vs non‐thrombectomy capable center. The median arrival to NIR notification times were compared.

Results

A total of 14,159 patients (6,726 AI and 7,433 non‐AI) were included. The median ATN for AI was 57.5 min [40.3, 85.0] and non‐AI was 88.5 min [63.0, 116.3; Δ
min
= 31.0 min, p < 0.0001]. The median ATN for those at a thrombectomy center (TC) with AI was 49.0 min [36.0, 75.0] and non‐AI was 81.0 min [52.5, 97.8], p = 0.0077. The median ATN for non‐thrombectomy centers (non‐TC) with AI was 73.0 min [56.0, 115.5] and non‐AI was 90.0 min [66.5, 120.5], p = 0.0563. [TS1] . There was no difference in the AI vs non‐AI groups for door to needle times with thrombolytics at thrombectomy or non‐thrombectomy centers.

Conclusions

This large, multicenter study demonstrated a 31‐minute faster arrival to neurointerventionalist notification time with the aid of RapidAI®. A significant reduction in NIR notification times at both TC and non‐TC sites highlights the impact of AI software on expediting acute stroke care.